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MEDICAL  JURISPRUDENCE 

AND 

TOXICOLOGY 

REESE 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/textbookofmedica1902rees 


TEXT-BOOK 


MEDICAL  JURISPRUDENCE 


TOXICOLOGY 


BY 


JOHN  J.  REESE,  M.  D. 


LATE   PROFESSOR   OF    MEDICAL   JURISPRUDENCE    AND   TOXICOLOGY    IN  THE  UNIVERSITY   OF 

PENNSYLVANIA  ;     LATE    PRESIDENT   OP  THE   MEDICAL    JURISPRUDENCE 

SOCIETY    OF    PHILADELPHIA 


SIXTH  EDITION 


REVJSED   BY 

HENRY   LEFFMANN,  A.  M.,  M.  D. 

PROFESSOR    OF    CHEMISTRY    AND    TOXICOLOGY    IN    THE    WOMAn's     MEDICAL    COLLEGE    OF 

PENNSYLVANIA  ;    PATHOLOGICAL  CHEMIST  TO   THE   JEFFERSON   MEDICAL 

COLLEGE    HOSPITAL;     VICE-PRESIDENT    (BRITISH) 

SOCIETY   OF   PUBLIC    ANALYSTS 


PHILADELPHIA  : 
P.    BLAKISTON'S    SON   &   CO. 

rOI2    WALNUT    STREET. 
1902 


Entered,  according  to  Act  of  Congress,  in  the  year  1902,  by 

P.    BLAKISTON'S   SON   &   CO., 

In  the  Office  of  the  Librarian  of  Congress,  at  Washington,  D.  C. 


PREFACE  TO  THE  SIXTH   EDITION. 

Since  the  publication  of  the  last  edition  of  this  work  the 
subject  of  toxicology  has  been  much  developed.  The 
introduction  of  numerous  synthetic  organic  bodies,  and  the 
extensive  use  of  some  of  them  as  household  remedies  have 
given  rise  to  many  instances  of  accidental  and  suicidal 
poisoning.  Current  medical  literature  shows  that  phenol 
is  becoming  one  of  the  most  common  agents  for  self-destruc- 
tion, while  the  extensive  use  of  water-gas  greatly  increases 
the  list  of  accidental  poisonings. 

Several  new  phases  of  treatment  may  be  noted.  Free 
washing  out  of  the  stomach  is  evidently,  whenever  possible, 
a  highly  beneficial  procedure.  The  employment  of  alcohol 
in  phenol  poisoning  is  an  important  advance.  Potassium 
permanganate  has  also  found  valuable  applications.  It  is 
also  to  be  noted  that  the  long-current  belief  in  the  anti- 
dotal value  of  atropin  in  morphin  poisoning  is  practically 
abandoned. 

The  editor  has  sought  to  include  the  recent  data  of  trust- 
worthy character  and  has  inserted  brief  descriptions  of  many 
cases  recently  reported.  The  general  character  of  the  book 
as  it  left  the  hand  of  its  distinguished  author  has  been 
retained. 


ABSTRACT   FROM   PREFACE  TO   FIRST 
EDITION. 


This  Text-Book  has  been  written  more  particularly  to 
meet  the  wants  of  students  of  Legal  Medicine,  The 
author  is  aware  that  the  field  has  already  been  occupied 
by  able  and  popular  treatises  on  Medical  Jurisprudence, 
well  known  to  the  professions  of  Medicine  and  Law ;  but 
an  experience  of  over  twenty  years  as  a  public  teacher 
of  this  branch  of  science  has  convinced  him  that  students 
in  both  these  professions  who  desire  to  acquire  a  knowl- 
edge of  Medical  Jurisprudence  are  too  often  deterred  from 
their  purpose  by  being  confronted  by  the  ponderous  works 
of  recognized  masters,  extending  to  three,  and  even  six, 
large  octavo  volumes. 

To  avoid  the  above  objection,  the  author  of  the  present 
work  has  endeavored  to  condense  into  a  handy  volume  all 
the  essentials  of  the  science,  and  to  present  the  various 
topics  in  a  simple  and  familiar  style,  giving  greater  promi- 
nence, of  course,  to  those  of  the  greatest  practical  impor- 
tance. 

The  author  has  not  hesitated  to  avail  himself  freely  of 
the  materials  so  abundantly  presented  in  the  elaborate  and 


Vin  ABSTRACTS  FROM  PREFACE  TO  FIRST  EDITION. 

classic  works  of  Casper,  Taylor,  Beck,  Wharton  and  Stille, 
Tidy,  Guy,  Tardieu,  and  others,  always  desiring  to  give 
due  credit  to  the  authority  quoted,  and  usually  doing  so 
at  the  time  ;  and  he  would  embrace  this  opportunity  to 
express  his  obligations  to  these  authorities.  He  is  sin- 
cerely desirous  to  encourage  an  increasing  interest  in  the 
students  of  both  Medicine  and  Law  for  that  most  important, 
but  too  much  neglected,  subject— Forensic  Medicine  ;  and 
he  would  indulge  the  hope  that  the  present  treatise,  in  its 
unpretentious  size  and  style,  may  aid  in  so  doing. 


CONTENTS. 


CHAPTER  I. 

PAGE 

Definition. — Importance  to  Students  of  Medicine  and  Law. — Order  of 
Proceeding  in  a  Medico-legal  Case. — The  Coroner's  Inquest. — The 
Criminal  Court.  —  Medical  Evidence.  —  Medical  Experts.  —  Dying 
Declarations, i? 

CHAPTER  II. 

Phenomena  and  Signs  of  Death. 

Molecular  and  Somatic  Death. — The  Immediate  Cause  of  Death  to  be 
found  in  the  Heart,  Lungs,  or  Brain. — Post-mortem  Evidences  of 
these. — The  "  Signs  of  Death." — Cessation  of  Respiration  and  Cir- 
culation.— Changes  in  the  Eyes. — Pallor  of  the  Body. — Loss  of  Animal 
Heat. — Post-mortem  Caloricity.— Rigor  Mortis. — Post-mortem  Lividity, 
or  Suggillation. — Putrefaction. — External  and  Internal  Signs. — Adi- 
pocere. — Mummification. — How  Long  Since  the  Death  ?      .        ...      28 

CHAPTER  III. 

Medico-legal  Investigations. — The  Post-mortem. 

Responsibility  Involved. — Accuracy  and  Method  Necessary. — Examina- 
tion of  the  Surroundings. — External  Examination  of  the  Body. — 
Internal  Examination. — Details  of  the  Examination. — Measurements 
and  Weights. — Notes 60 

CHAPTER  IV. 

Presumption  of  Death  and  of  Survivorship. 

Cases  Involving  Presumption  of  Death  and  of  Survivorship. — French 
Law  of  Survivorship. — Probabilities  Afforded  by  Age,  Sex,  and  Mode 
of  Death,     74 


TABLE    OF    CONTENTS. 


CHAPTER  V. 


Personal  Identity.  i-age 

Important  Medico-legal  Bearings. — I.  Identification  of  the  Living. — 
Personal  Appearance.  —  Peculiar  Bodily  Marks. — Remarkable  Cases. — 
II.  Identification  of  the  Dead. — Mutilated  Remains. — Identification, 
by  Means  of  the  Skeleton,  as  to  Age,  vSex,  and  Stature. — Rules  of  Pro- 
portion.— Fractures,  Deformities,  and  Callus. — Age  of  Bones. — Ex- 
amination of  Hairs  and  Fibers, 78 

CHAPTER  VI. 
Causes  Producing  Violent  Death. 

Death  from  Wounds. — Definition  of  a  Wound. — Danger  of. — Examina- 
tion of  the  Body. — Absence  of  External  Marks  of  Violence. — 
Wounds  Made  Before  and  After  Death. — Hemorrhage. — Ecchymoses. 
Classification. — Homicidal,  Suicidal,  and  Accidental  Wounds. — Gun- 
shot Wounds. — Differ  from  other  Wounds. — Deflection  of  the  Ball. — 
Wounds  made  by  Shot,  Wadding,  and  Powder. — Cause  of  Death  from 
Wounds. — Wounds  of  the  Head,  Neck,  Spine,  Chest,  and  Abdomen,   loi 

Examination  of  Blood  Stains. 

Importance  of  their  Identification. — Several  Methods  of  Identifying. — 
The  Chemical  Tests. — The  Microscopic  Test. — The  Spectroscopic 
Test. — The  Micrometric  Test. — Blood  Crystals. — Comparative  of  Blood 
Corpuscles, 131 

Burns  and  Scalds. 

Definition. — Classification. — Symptoms. — Cause  of  Death. — Post-mortem 
Appearances. — Burns  Made  Before  and  After  Death. — Accidental, 
Suicidal,  and  Homicidal  Burns. — Spontaneous  Combustion,      ....     148 

Death  from  Different  Forms  of  Apnea  (Asphyxia). 

Death  from  Suffocation. — Accidental,  Suicidal,  and  Homicidal  Suffoca- 
tion.— Post-mortem  Signs. — Asphyxia  from  Poisonous  Gases. — Char- 
coal Vapor. — Illuminating  Gas. — ^Vapors  from  Privies  and  Cesspools. — 
Death  by  Strangulation.— Modes  of  Strangulation.— External  Signs.— 
Internal  Lesions. — Accidental,  Suicidal,  and  Homicidal  Strangulation. 
Mark  of  the  Cord.— Death  by  Hanging.— Cause  of  Death.— Post- 
mortem Appearances.— Cord  Marks,— Generally  Suicidal.— Death  by 


TABLE    OF    CONTENTS.  XI 

PAGE 

Drowning. — Mode  of  Death. — Time  Required. — Signs  of  Death, 
External  and  Internal. — Accidental,  Suicidal,  and  Homicidal  Drown- 
ing,     ^54 

Death  by  Electricity. 
Medico-legal  Relations. — Mode  of  Death. — Post-mortem  Signs,  ....     185 

Death  from  Heat  and  Cold. 

Diverse  Effects  of  Heat  upon  the  Body. — Post-mortem  Appearances. — 
Effects  of  Cold. — Post-mortem  Appearances 189 

Death  by  Starvation. 

Accidental,  Homicidal,  and  Suicidal  Starvation. — Pretended  Cases  of 
Voluntary  Starvation. — Symptoms  and  Post-Mortem  Signs. — Medico- 
legal Relations, ^93 

CHAPTER  VII. 
Feigned  Diseases. 

Great  Variety  of  Simulated  Diseases. — Fictitious  and  Factitious  Diseases. 
— General  Rules  for  Diagnosis. — Special  Diagnosis, 197 

CHAPTER  VIII. 
Pregnancy. 

Cases  where  it  becomes  the  Subject  of  Medico-legal  Investigation. — Signs 
of  Pregnancy,  Certain  and  Uncertain.  —  Corpus  Luteum.  —  Uncon- 
scious Pregnancy. — Pregnancy  in  the  Dead, 210 

CHAPTER  IX. 
Criminal  Abortion,  or  Feticide. 

Definition. — Frequency  of  Abortion  from  Natural  Causes. — Proofs  that  a 
Fetus  has  been  Destroyed. — Signs  Afforded  by  the  Mother. — Age  of 
the  Fetus. — Means  Employed, 220 


XU  TABLE    OF    CONTENTS. 

CHAPTER  X. 

FAOB 

Infanticide. 

Definition. — A  Live  Birth. — Questions  Relating  to  the  Infant. — Was  it 
Born  Alive. — Signs  of  Death  Before  Birth. — Proofs  of  a  Live  Birth 
derived  from  the  Lungs. — The  Hydrostatic  Test. — Proofs  of  a  Live 
Birth  derived  from  the  Organs  of  Circulation  and  the  Abdominal 
Organs. — Peculiarities  of  the  Fetal  Circulation. — Uncertainty  of  these 
Signs. — Desiccation  of  the  Umbilical  Cord. — Proofs  of  a  Live  Birth 
from  the  Stomach  and  Intestines. — Causes  of  Death  in  the  Newborn 
Child. — (l)  Causes  Acting  during  Birth. — Compression  of  and  by  the 
Cord.  —  Protracted  Delivery.  —  Debility,  Hemorrhage,  Fracture  of 
Skull. — (2)  Causes  Acting  after  Birth. — Congenital  Malformation  and 
Disease. — Exposure. — Improper  Food. — Wounds  and  Injuries. — Suf- 
focation. — Strangling.  — Drowning. — Poisoning.  — Accidental  Causes.  — 
Mode  of  Conducting  the  Examination.  —  Questions  Relating  to  the 
Mother. — Signs  of  Delivery. — Early  Signs.  —  Examination  of  the 
Milk. — Concealed  Delivery. — Concealment  of  Birth. — Pretended  De- 
livery,     234 

CHAPTER  XI. 

Legitimacy — Inheritance. 

Medico-legal  Importance. — Ordinary  Term  of  Human  Gestation. — Pro- 
tracted Gestation. — Argument  from  Analogy  of  the  Lower  Animals. — 
Premature  Delivery. — Early  Viability  of  the  Child. — Live  Birth  in 
Civil  Cases. — Tenancy  by  Courtesy. — Laws  Concerning  Legitimacy. 
— Paternity. — Affiliation. — Superfetation. — Double  Sex  in  Hermaphro- 
ditism.— Impotence  and  Sterility. — Causes  of  Impotence. — Procrea- 
tive  Power  in  the  Male. — Crypsorchides  and  Monorchides. — Sterility. 
— Procreative  Power  in  the  Female. — Legal  Decisions,  ......    274 

CHAPTER  XII. 

Rape. 

Legal  Meaning.— Duty  of  the  Examiner. — Rape  on  Children. — May  be 
Confounded  with  Disease. — Rape  on  Adult  Women. — Possibility  of, 
without  Consent. — If  Unconscious. — Effects  of  Ether. — Philadelphia 
Case. — Evidences  of  Rape  on  Adults. — Condition  of  the  Hymen. — 
Seminal  Stains. — Post-mortem  Evidences  of  Rape. — Unnatural  Crimes. 
— Legal  Relations  of  Rape, 294 


TABLE    OF    CONTENTS.  Xlil 

CHAPTER  XIII. 

Insanity.  page 

Medico-legal  Difficulties  of  Insanity. — Civil  and  Criminal  Responsibility. 
— Legal  Terms. — Illusions,  Hallucinations,  and  Delusions. — Conceal- 
ment of  Delusions. — Lucid  Intervals. — Classification. — Defective  De- 
velopment of  the  Faculties. — Idiocy,  Physical  Marks  of. — Pathological 
Marks. — Imbecility. — Cretinism. — Legal  Relations  of  Idiocy  and  Im- 
becility. Lesions  of  the  Mental  Faculties  Subsequent  to  their  De- 
velopment.— General  Intellectual  Mania. — Symptoms. — Melancholia. 
—  Symptoms. —  Partial  Intellectual  Mania. —  Moral  Mania. —  Mono- 
mania.— Kleptomania.  — Pyromania.  — Dipsomania.  — Responsibility  of 
Drunkards. — Homicidal  and  Suicidal  Mania. — General  Paresis. — De- 
mentia.— Puerperal  Insanity. — Somnambulism. — Epileptic  Insanity. — 
Post-mortem  Lesions. — Medico-legal  Relations  of  Insanity. — Depriva- 
tion of  Liberty.  —  Signing  Certificates  of  Insanity.  —  Testimony  in 
Criminal  Cases.  —  Testamentary  Capacity.  —  Opinions  in  Relation  to 
Marriage  and  Education  of  Children.  — Criminal  Responsibility. — The 
Plea  of  Insanity  as  a  Bar  to  Capital  Punishment.  —  Importance  of  a 
Correct  Understanding  of  the  Subject. — A  mere  "Knowledge  of 
Right  and  Wrong ' '  not  sufficient.  —  Condition  of  the  Will,  or  Self- 
Control.  —  Emotional  Insanity.  —  Simulated  or  Feigned  Insanity.  — 
Pretended  Insanity  in  Criminals.  —  Importance  of  Ascertaining  the 
Motive.  —  Means  taken  to  conceal  the  Crime.  —  Mania,  the  Form 
usually  Feigned, 314 


CHAPTER  XIV. 
Malpractice. 

Definition. — The  Physician  not  an  Insurer. — Certain  Established  Princi- 
ples.— "Ordinary  Skill." — Errors  in  Judgment. — Frequency  of  Civil 
Suits. — Causes  Leading  to  Suits  for  Malpractice. — Laws  in  the  U.  S. 
affecting  Inebriety  in  Physicians. — Liability  of  Druggists,        ....    365 

CHAPTER  XV. 
Life  Insurance. 

Meaning  of  the  Term. — Conditions  of  the  Policy. — Concealment  of  Facts. 
— Relation  of  Intemperance  and  Suicide  to  Life  Insurance. — Cases,  .    ,  376 


XIV  TABLE     OF     CONTENTS. 

CHAPTER  XVI. 
Toxicology.— (Death  from  Poisoning.)  pagb 

Definition  of  a  Poison.  —  Effects. —  Proofs  of  Absorption.  —  Subsequent 
Disposition  of  the  Poison. — Elimination. — Cause  of  Death. — Circum- 
stances Modifying  their  Action. — Antagonism  of  Poisons  — Evidences 
of  Poisoning. — i.  Evidences  from  Symptoms. — 2.  From  Post-mortem 
Lesions. — 3.  Chemical  Analysis. — Post-mortem  Imbibition  of  Poisons. 
—  Rules  in  Performing  a  Toxicologic  Analysis. — 4.  Physiologic  Ex- 
periments.—  5.  Circumstantial  Evidence.  — Medico-legal  Conclusions. 
— Classification, 384 

CORROSIVE   IRRITANTS. 

Mineral  Acids. 

Certain  Common  Symptoms. — Post-mortem  Appearances. — Treatment. — 
Analysis.  —  Toxicologic  Examination  for  the  Different  Acids.  —  Sul- 
phuric, Nitric,  and  Muriatic  Acids, 414 

Alkalies  and  their  Salts. 

Potassa,  Soda,  and  Ammonia. — Similarity  of  Effects. — Symptoms. — Fatal 
Dose. —  Treatment. —  Post-mortem  Appearances. —  Analysis. — Poison- 
ing by  the  Alkaline  and  Earthy  Salts. — Potassium  Nitrate. — Potassium 
Chlorate.  —  Potassium  Bitartrate.  —  Potassium  Sulphate.  —  Alum. — 
Chlorated  Potassa  and  Soda. — Salts  of  Barium,  .        .......    426 

IRRITANTS  PROPER. 

Phosphorus. —  Symptoms. —  Fatal  Dose. —  Treatment. —  Morbid  Appear- 
ances. —  Diagnosis. —  Analysis. —  Amorphous  Phosphorus. — Poisoning 
by  lodin,  Bromin,   Chlorin,  and  Chlorin  Oxids,       435 

Arsenic. 

Arsenic. —  Arsenous  Oxid. —  Properties. —  Symptoms.— Chronic  Poison- 
ing. —  Fatal  Dose.  —  Treatment.  —  Post-mortem  Signs.  —  Analysis.  — 
Toxicologic  Examination. — Other  Preparations  of  Arsenic, 449 

Antimony  Compounds  (Tartar  Emetic). 

Properties  of  Tartar  Emetic. —  Symptoms. —  Fatal  Dose.  —  Post-mortem 
Appearances.  —  Slow  Poisoning.  —  Analysis.  —  Toxicologic  Examina- 
tion,  474 


TABLE    OF    CONTENTS.  XV 

Mercury  Compounds  (Corrosive  Sublimate).  page 

Corrosive  Sublimate.  —  Properties.  —  Symptoms.  —  Post-mortem  Appear- 
ances.—  Fatal  Dose. — Antidotes.  —  Analysis. — Toxicologic  Examina- 
tion.— Salivation, 4^4 

Lead  Compounds. 

frequency  of  Chronic  Poisoning. — Lead  Acetate. — Symptoms. — Treat- 
ment.— Post-mortem  Appearances. — Painters'  Colic. — Lead  Palsy. — 
Toxicologic  Examination.  —  Other  Preparations  of  Lead.  —  Lead 
Chromate,     .    , 497 

Copper  Compounds. 

Accidental  Poisoning.  —  Copper  Salts.  —  Fatal  Dose.  —  Treatment.  — 
Morbid  Appearances. — Analysis. — Toxicologic  Examination,    ...    506 

Zinc  and  Magnesium  Compounds. — Bismuth. — Tin,  Iron,  and  Chrom- 
ium Compounds,  S'fS 

Vegetable  and  Animal  Irritants. 

Oxalic  Acid. — Sources  of  the  Acid  in  Nature. — Symptoms. — Fatal  Dose. 
Treatment. — Morbid  Appearances. — Analysis. — Toxicologic  Examina- 
tion. —  Potassium  Oxalates.  —  Carbolic  Acid.  —  Lysol.  —  Pyrogallol. 
Sodium  Salicylate.  —  Betanaphtol.  —  Naphthalene.  —  Kerosene  and 
Gasolin.  —  Croton  Oil,  Elaterium,  Castor  Oil  Beans,  Colchicum, 
Savin  and  Oleander.  —  The  Hellebores. — Veratrin. — Gelsemium 
(Yellow  Jasmine). — Gelsemin  and  Gel.semic  Acid. — Poisonous  Mush- 
rooms.— Lily  of  the  Valley. — Camphor, 521 

Animal  Irritants. 

Cantharides. — Poisonous  Animal  Food. — Sausage  Poison. — Trichinosis. 
Cheese  Poison. — Poisonous  Fish. — Putrescent  Food. — Poisoned  Flesh,  548 


NEUROTIC  POISONS. 

Cerebral  Neurotics.  —  ( i )  Narcotics. 

Opium.     Nature  of   Opium. — Poisonous  Symptoms. — Fatal   Period  and 
Dose.     Treatment. — Morphin.  —  Properties. — Tests. — Meconic  Acid. 


XVI  TABLE   OF   CONTENTS. 


PAGE 


— Tests. — Toxicologic  Examination. — Alcohol. — Acute  Alcoholism. — 
Symptoms. — Post-mortem  Lesions.  —  Analysis.  —  Detection  in  the 
Tissues. — Methyl  Alcohol. — Formaldehyde,        .         554 

(2)  Anesthetics. 
Ether,  Chloroform,  and  Chloral  Hydrate, 572 

Spinal  Neurotics. 

Nux  Vomica. — Strychnin.  —  Effects. — Fatal  Dose. — Treatment. — Post- 
mortem Lesions. — Diagnosis. — Analysis. — Interferences. — Physiologic 
Test. — Toxicologic  Examination.  — Brucin, 57^ 

Cerebro-spinal  Neurotics.  —  Deliriants. 

Belladonna.  —  Symptoms.  —  Atropin. — Fatal  Dose. — Treatment. — Post- 
mortem Appearances. — Analysis. — Toxicologic  Examination. — Poison- 
ing by  Stramonium,  Hyoscyamus,  Solanum,  and  Cocain, 601 

Depressants. 

Tobacco  and  Lobelia.  —  Effects  of  Tobacco.  —  Post-mortem  Lesions. 
Nicotin. — Properties. — Toxicologic  Examination. — Lobelia,     ....    613 

Hemlock. — Symptoms. — Post-mortem  Appearances. — Conin. — Reactions. 
Toxicologic  Examination. — Other  Poisonous  Hemlocks. — Aconite  and 
Calabar  Bean. — Properties  of  the  Aconitum  Napellus. — Effects. — Post- 
mortem Appearances.— Aconitin. — Fatal  Dose. — Treatment. — Analysis. 
Toxicologic  Examination. — Calabar  Bean. — Properties. — Eserin,     .    .    620 

Asthenics. 

Hydrocyanic  Acid. — Natural  Occurrence  in  Vegetables. — Pure  and  Offi- 
cinal Acids. — Symptoms. — Fatal  Period  and  Dose. — Treatment. — Post- 
mortem Appearances. — Tests. — Toxicologic  Examination. — Potassium 
Cyanid. — Oil  of  Bitter  Almonds. — Cherry-laurel  Water. — Nitrobenzene, 
Anilin,  Antipyrin,  Antifebrin,  and  Trional. — Symptoms. — Post-mor- 
tem Lesions. — Fatal  Dose. — Digitalin. — Analysis. — Toxicologic  Ex- 
amination.— Case  of  De  la  Pomerais. — Cocculus  Indicus,  .    ,    .    630 

Alkaloids  of  Putrefaction,  —  Ptomains, 650 


TEXT-BOOK 

OF 

MEDICAL  JURISPRUDENCE 

4 


ANJD 


TOXICOLOGY. 


CHAPTER    I. 

Medical  Jurisprudence,  Legal  or  Forensic  Medicine, 
may  be  defined  to  be  the  science  which  applies  the  knowledge 
of  Medicine  to  the  requirements  of  Law.  In  the  discovery 
of  truth,  the  great  purpose  of  Law,  every  department  of 
human  knowledge  should  be  made  to  assist.  Cases  affect-^ 
ing  life,  reputation,  or  property,  and  requiring  for  elucida-^ 
tion  an  appeal  to  medical  knowledge,  are  termed  medico- 
legal cases,  and  the  science  of  the  application  of  medicine  to 
them  is  named  Medical  Jurisprudence. 

The  students  of  Medicine  and  Law  are  equally  interested 
in  a  knowledge  of  this  science,  and  it  should  require  no 
argument  to  show  its  importance  to  members  of  these 
professions. 

Many  cases  brought  before  a  court  can  only  be  settled 

by  an  appeal  to  medical  knowledge ;  sometimes  it  is  to  one 

department  of  medicine,  and  sometimes  to  another ;  and  it 

not  infrequently  happens  that  several  branches  of  the  science 

2  17 


I  8  MEDICAL   JURISPRUDENCE, 

may  be  called  into  requisition  in  order  to  aid  in  arriving  at 
a  proper  decision. 

It  is  more  particularly  when  the  physician  appears  upon 
the  witness  stand,  and  assumes  the  functions  of  the  medical 
ivitncss,  that  medico-legal  knowledge  is  of  the  most  impor- 
tance. After  he  has  accomplished  the  investigation  of  some 
case  there  remains  the  duty  of  giving  the  results  of  his  in- 
vestigations to  the  court  in  the  form  of  evidence.  This  will 
be  more  manifest  as  we  detail  the  mode  of  proceeding  in  a 
criminal  case. 

The  Coroner's  Inquest. — The  first  public  duty  usually 
imposed  upon  the  physician  who  has  been  in  attendance,  or 
has  investigated  a  case  of  violent  death,  is  to  testify  at  the 
coroner's  inquest.  In  many  civilized  countries,  especially 
English-speaking  communities,  a  special  officer,  the  coroner, 
is  appointed  to  investigate  the  unknown  or  unexplained 
causes  of  sudden  death.  For  example,  a  body  is  discovered 
with  or  without  marks  of  external  violence,  or  dragged  out 
of  the  river ;  the  body  of  a  new-born  child  has  been  found 
in  a  well  or  cess-pool,  or  floating  in  the  water ;  a  person  is 
discovered  dead  at  some  hotel,  far  distant  from  his  home ; 
or  a  person  in  apparent  health  suddenly  drops  dead  in  the 
street.  In  these  and  in  analogous  cases  the  law  provides 
for  an  investigation  to  ascertain  the  cause  and  circumstances 
of  the  death  ;  and,  if  due  to  violence,  then  the  nature  of  it — 
i.  e.,  whether  from  a  wound  (gunshot  or  otherwise),  from  a 
bludgeon,  an  axe,  hammer,  or  other  blunt  weapon  ;  or 
whether  occasioned  by  a  fall.  In  the  absence  of  all  external 
marks  of  violence,  then,  might  the  death  not  have  been 
produced  by  poison  ?  In  each  one  of  these  cases  a  further 
question  must  be  solved — was  the  death  homicidal,  suicidal, 
or  accidental  ? 


THE    coroner's    INQUEST.  1 9 

The  coroner's  jury  consists  of  a  few  men  (the  number 
varies  in  different  places),  mostly  selected  from  the  district 
in  which  the  inquest  is  held.  Their  duty  consists  in  (i) 
viewing  the  body  and  establishing  its  identity  and  (2)  in 
holding  the  inquest,  which  is  a  sort  of  petty  court,  wherein 
inquiry  is  made  as  to  the  cause  of  death,  and  (in  case  of 
homicide)  to  ascertain,  if  possible,  the  guilty  person.  Wit- 
nesses are  examined,  and  the  person  who  has  performed  the 
post-mortem  examination  makes  a  report  and  gives  his 
opinion  as  to  the  cause  of  death.  The  jury  consult  and 
render  a  verdict.  In  some  cases,  particularly  in  cities, 
where  the  coroner  has  one  or  more  specially  appointed 
physicians,  it  is  not  considered  necessary  that  the  jury  should 
personally  view  the  body  ;  it  is  regarded  as  sufficient  if  the 
body  has  been  identified  by  the  examining  physician,  and 
the  autopsy  reported. 

The  special  duty  of  the  coroner's  inquest  is  to  discover 
the  cause  of  death  ;  it  does  not  fall  within  his  province  to 
discover  the  individual  who  caused  it.  Nevertheless,  it 
often  happens  that,  in  the  course  of  the  investigation,  sus- 
picion may  so  strongly  point  to  some  one  as  to  warrant  the 
coroner  committing  the  suspect  to  prison  to  await  further 
investigation.  The  usual  verdict  in  cases  of  violent  death 
(shown  to  have  been  neither  suicidal  nor  accidental)  is  that 
of  murder  or  manslaughter,  against  some  person  or  persons, 
known  or  unknown. 

The  office  of  coroner,  as  at  present  constituted  in  many 
places,  exhibits  antiquated  and  inconvenient  methods.  In 
Massachusetts  the  office  has  been  abolished,  the  investiga- 
tion of  sudden  or  suspicious  deaths  being  carried  out  by 
physicians,  called  "  Medical  Examiners,"  who  do  not  refer 
evidence  to  a  special  jury,  but  can  place  any  suspected 
criminal  in  the  charge  of  the  courts. 


20  MEDICAL    JURISPRUDENCE. 

The  post-mortem  examination  is  an  inseparable  part  of 
the  coroner's  inquiry  in  a  case  of  this  character,  and  con- 
stitutes its  most  important  factor.  It  should  be  performed 
carefully  and  thoroughly.  The  autopsy  should  be  per- 
formed deliberately,  and  by  daylight  if  possible.  It  will 
always  be  an  advantage  if  the  examination  be  performed  by 
two  experts. 

In  giving  evidence  before  the  coroner's  jury,  the  medical 
witness  must  not  undervalue  the  importance  of  the  situ- 
ation ;  nor  forget  that  the  testimony  is  generally  recorded, 
and  will  be  available  at  a  subsequent  trial.  This  fact  shows 
the  importance  of  drawing  up  the  report  with  due  care  and 
accuracy. 

The  Criminal  Court. — If  the  coroner's  jury  or  other  pre- 
liminary method  of  inquiry  indicates  the  probability  that  a 
crime  has  been  committed,  the  matter  is  referred  to  the 
prosecuting  officer,  generally  called  in  the  United  States, 
the  District  Attorney,  who  prepares  a  "bill  of  indictment" 
that  is  a  document  which  sets  forth  the  nature  of  the  crime 
as  far  as  known  and  the  name  of  any  suspected  person. 
This  bill  is  submitted  to  a  special  body  of  persons,  called 
the  grand  jury,  which  deliberates  in  secret,  usually  calling 
only  such  witnesses  as  the  authorities  indicate,  though  it 
has  power  to  send  for  other  persons.  If  the  grand  jury  de- 
cides that  there  is  sufficient  evidence  to  justify  a  trial  in 
open  court,  the  document  is  returned  marked  "  true  bill,"  but 
if  not  deemed  so,  the  bill  is  "ignored."  A  true  bill  leads 
to  a  trial.  The  indictment  is  read  in  open  court  and  the 
accused  is  required  to  plead  guilty  or  not  guilty.  To  this 
trial  the  medical  witness  is  summoned  to  appear  by  a  sub- 
pena,  which  must  be  obeyed.  He  will  undergo  a  strict  and 
severe  examination  as  to  his  opinions  and  observations  on 


JUDICIAL    PROCEDURE.  21 

the  case.  He  will  be  cross-examined  as  to  his  professional 
knowledge  and  acquirements,  the  extent  of  his  opportunities 
for  making  such  investigations  as  the  one  pending,  the  ac- 
curacy of  his  post-mortem  or  toxicologic  examination,  and 
other  matters  which  may  annoy  and  confuse  him  to  no 
small  degree,  unless  he  be  prepared  beforehand  by  medico- 
legal knowledge  and  training.  A  witness  properly  fortified 
need  have  no  fear  for  himself;  for,  as  he  goes  upon  the 
stand  honestly  to  testify  to  the  truth,  "  he  need  only,"  to 
quote  the  language  of  the  late  Dr.  Taylor,  "  bear  in  mind 
two  considerations :  first,  that  he  should  be  thoroughly  pre- 
pared on  all  points  of  the  subject  on  which  he  is  to  give 
evidence  ;  and,  secondly,  that  his  demeanor  should  be  that 
of  an  educated  gentlemen,  and  suited  to  the  serious  occasion 
on  which  he  appears." 

In  regard  to  medical  evidence  several  points  require 
brief  notice.  After  opening  the  case  before  the  court,  the 
prosecuting  attorney  calls  witnesses  and  examines  them 
"according  to  the  rules  of  evidence"  ;  this  is  technically 
called  the  exmni nation  in  chief.  The  cross  examination 
follows  ;  this  is  conducted  by  the  counsel  for  the  defense, 
and  may  be  aimed  at  contradicting  and  overthrowing,  if 
possible,  the  previous  testimony.  A  counsel  for  the  de- 
fense is  allowed  very  considerable  latitude  in  the  cross- 
examination  of  the  witness,  and  it  will  be  necessary  for  the 
witness  to  exercise  considerable  self-control,  since  it  is  only 
in  this  way  that  a  brow-beating  attorney  can  be  parried. 
The  witness  must  also  remember  that  there  are  technical 
methods  in  the  law  which  are  not  comprehended  by  others, 
and  it  is  especially  advisable  that  if  objection  be  made  by 
either  attorney  to  any  question,  the  witness  should  pause 
until  the  matter  is  decided  by  the  judge.     It  is  inadvisable 


22  MEDICAL   JURISPRUDENCE. 

for  a  witness  to  appeal  to  the  judge  for  protection  against  a 
line  of  questions.  An  honest  and  properly  informed  phy- 
sician has  nothing  to  fear  from  a  lawyer.  Reexamination 
sometimes  follows  the  cross-examination  of  the  witness, 
when  it  becomes  necessaiy  to  clear  up  or  explain  any 
matter  that  may  have  been  obscured  by  the  cross-ex- 
amination. 

After  the  examination  of  the  witnesses  called  by  the 
prosecuting  officers,  that  of  the  witnesses  for  the  defense  fol- 
lows, and  the  same  general  line  of  examination  is  pursued. 
When  expert  witnesses  for  the  defense  are  called,  a  most 
unpleasant  exhibition  frequently  takes  place,  one  expert 
directly  contradicting  another  on  the  opposite  side.  Such 
professional  tilting  is  sometimes  sneeringly  designated  as 
the  "war  of  the  experts,"  and  is  certainly  deeply  to  be  re- 
gretted, as  it  tends  greatly  to  prejudice  both  the  court  and 
the  public  against  expert  testimony  in  general. 

It  is  well  to  understand  the  difference  between  an  ordi- 
nary and  an  expert  witness.  The  former  testifies  only  to 
facts  which  he  has  seen,  or  heard,  or  learned  from  personal 
observation.  The  "expert"  or  skilled  witness  does  not 
necessarily  testify  to  facts,  but  gives  his  opinion  on  facts 
observed  by  himself  or  testified  to  by  others.  An  expert 
witness  is  supposed  to  be  specially  skilled  in  the  matter  on 
which  he  is  to  testify.  It  is  just  here  that  much  difficulty 
arises  in  cases  involving  expert  evidence.  The  so-called 
"experts"  are  often  selected  with  the  intention  that  they 
shall  advocate  particular  views  or  belittle  in  every  possible 
way  the  ability  or  work  of  the  experts  on  the  opposite  side. 

The  expert  witness  has  his  rights  as  well  as  his  duties  and 
responsibilities.  One  of  these  rights  is  his  compensation. 
It  has  often  been  made  a  subject  of  just  complaint  that  an 


MEDICAL    EVIDENCE EXPERTS.  23 

expert  witness  is  placed  upon  the  stand  and  his  professional 
opinions,  which  may  be  of  the  utmost  value  in  the  pending 
case,  extorted  from  him  piecemeal  by  the  questionings  of 
counsel,  and  yet  he  receives  as  his  compensation  merely 
the  pay  of  an  ordinary  witness.  Some  legal  authorities 
admit  that  the  expert  is  not  bound  to  submit  to  this  impo- 
sition, and  that  he  is  entitled  to  a  special  fee  for  his  services. 
In  this  country  the  practice  of  the  courts  in  relation  to  the 
compensation  of  medical  experts  is  not  settled.  In  many 
states  the  law  allows  no  additional  compensation  to  the 
expert,  and  it  is  not  an  infrequent  practice  to  subpena  him 
as  an  ordinary  witness,  and  when  in  the  witness  box  to 
use  him  as  an  expert.  What  shall  the  expert  do  in  such  a 
case  ?  How  shall  he  conduct  himself  consistently  with  his 
own  dignity  and  proper  rights  ?  Certainly  the  court  would 
would  not  use  a  man's  private  property  —  the  work  of  his 
hands,  his  skilled  manual  labor,  or  the  product  of  his  farm 
or  merchandise  —  without  adequate  compensation;  why, 
then,  should  they  exact  from  him  that  which  is  the  result 
of  the  labor  of  his  brain,  than  which  nothing  can  be  more 
exclusively  and  definitely  a  man's  own  private  property? 
It  is  to  be  regretted  that  so  few  of  our  American  courts  and 
legislatures  have  appeared  to  recognize  the  true  bearings  of 
this  subject  so  that  with  us  the  old  practice  still  prevails 
of  affording  no  legal  protection  to  the  medical  expert  in  the 
matter  of  fees. 

It  rarely  happens  in  important  criminal  cases,  especially 
in  poison  cases,  that  either  the  prosecution  or  the  defense 
would  venture  to  trust  their  interests  to  a  reluctant  witness  ; 
and  certainly  he  would  be  a  reluctant  witness  who  had  been 
dragged  perhaps  hundreds  of  miles  from  his  home  and 
business  by  a  subpena  which  the  law  forces  him  to  obey. 


24  MEDICAL   JURISPRUDENCE. 

and  who,  after  spending,  it  may  be,  days  in  attendance  upon 
the  court,  is  compelled  to  give,  for  the  paltry  pittance  of 
the  wages  of  a  day-laborer,  that  which  has  cost  him 
years  of  labor  and  study  to  acquire,  in  the  shape  of  an 
opinion,  on  which  may  turn  the  question  of  life  or  death  to 
the  prisoner.  In  all  such  cases  the  ordinary  practice  is  to 
arrange  beforehand  with  the  expert  for  his  proper  fee,  and 
the  witness  should  be  admonished  to  look  carefully  about 
his  interests  in  this  matter.  Let  him  remember  that  the 
district  attorney,  who  usually  directs  the  affair,  may  have 
no  authority  to  pay  the  fee  ;  neither  does  this  authority 
always  lie  with  the  court.  The  responsible  parties  in  the 
case  are  often  the  county  commissioners,  or  some  equiva- 
lent county  authority.  With  these  alone  ought  the  expert 
to  make  his  arrangements,  and  always  previously  to  under- 
taking the  case  ;  and  to  these  alone  can  he  look,  legally, 
for  his  fee. 

As  regards  the  obligation  of  a  witness  to  obey  a  subpena 
when  he  is  to  be  questioned  only  as  to  his  opinion,  the 
mandate  of  the  court  in  this  country  is  obligatory ;  the 
witness's  duty  is  to  obey  it,  and  then,  if  not  previously, 
endeavor  to  arrange  about  his  compensation  before  giving 
his  evidence. 

The  subject  of  expert  testimony  has  engaged  the  atten- 
tion of  some  of  the  ablest  minds  in  both  the  professions  of 
law  and  medicine,  but  with  no  very  definite  results.  No 
doubt,  our  present  system  of  volunteer  medical  experts  is 
open  to  objections,  which,  under  our  present  laws,  cannot 
be  remedied.  A  system  is  much  advocated  of  each  State 
appointing  one  or  more  experts,  who  shall  be  State  officers, 
physicians  of  thorough  education  and  experience  and  train- 
ing in  this  particular  line,  who  shall  devote  their  time  and 


REMUNERATION    TO    EXPERTS.  25 

attention  exclusively  to  this  duty,  and  for  which  they  shall 
receive  an  adequate  compensation.  Such  an  office,  properly 
filled,  and  kept  aloof  from  all  political  considerations,  might 
be  of  real  benefit ;  but  it  would  not,  necessarily,  abolish  the 
unseemly  contention  of  the  experts  in  the  court  room,  for 
in  the  United  States  the  clause  in  the  Constitution  pro- 
viding that  in  every  criminal  trial  the  accused  shall  have 
the  power  to  call  witnesses  in  his  favor  and  be  confronted 
by  the  witnesses  against  him  will  permit  of  the  same  con- 
tentions between  experts  that  now  occur.  Moreover,  it  is 
not  likely  that  in  our  present  poHtical  system  a  satisfactory 
selection  of  "State  experts"  will  be  made.  Social  as  well 
as  political  influences  will  operate  to  control  such  appoint- 
ments, and  the  former  as  well  as  the  latter  are  capable  of 
promoting  unfit  persons.  The  system  of  State  experts  is 
in  vogue  in  some  countries  in  continental  Europe  ;  but  the 
method  of  criminal  procedure  is  different  in  such  places, 
and  does  not  exhibit  the  care  of  the  rights  of  the  accused 
which  is  the  principle  of  English  jurisprudence.  It  is 
worthy  of  note  that  some  eminent  authorities  in  continental 
Europe  are  advocating  the  adoption  of  some  phases  of  the 
English  system. 

There  are  a  few  practical  rules  relating  to  the  giving  of 
evidence  which  it  is  well  the  medical  expert  should  observe. 
He  should  prepare  himself  thoroughly  upon  all  the  points 
bearing  on  the  case  in  which  he  is  called  to  give  evidence. 
This  he  should  do  in  order  to  further  the  ends  of  justice, 
and  also  to  avoid  personal  censure.  He  should  be  accu- 
rate as  to  weights,  measures,  distances,  size,  relationship  of 
objects,  etc.,  never  guessing,  but  testifying  with  certainty 
and  precision. 


26  MEDICAL    JURISPRUDENCE. 

He  should  maintain  a  quiet,  dignified,  and  composed 
demeanor  on  the  stand,  not  exhibiting  any  irritabihty  of 
temper,  however  much  he  may  feel  provoked  by  the  rude- 
ness of  the  opposing  counsel.  He  should  beware  of  any 
display  of  arrogance  or  assumption  of  manner,  or  of  stub- 
borness  or  testiness  of  behavior,  which  are  sure  to  make 
him  appear  to  disadvantage  in  the  court  room. 

The  witness  should  give  his  answers  in  a  clear  and  audi- 
ble tone,  and  these  replies,  together  with  his  explanations, 
should  always  be  given  in  the  simplest  possible  language  ; 
and  they  should  be  free  from  all  ambiguity,  otherwise  they 
will  require  explanation,  which  is  apt  rather  to  weaken  the 
testimony.  It  will  be  better,  also,  for  him  to  avoid  all  vol- 
untary remarks,  and  confine  himself  closely  to  answering 
the  questions  put  to  him. 

He  should  never  be  afraid  frankly  to  confess  his  igno- 
rance. Nothing  is  more  dangerous  than  for  a  witness  to 
attempt  to  guess,  for  fear  of  being  thought  ignorant. 

He  should  particularly  avoid  the  use  of  all  technical 
expressions  and  learned  formulae  in  giving  his  descriptions. 
Pomposity  and  pedantry  should,  of  course,  be  avoided  by 
every  sensible  and  well-bred  witness,  since  they  are  certain 
to  expose  him  to  ridicule  and  contempt. 

Dying  Declarations. — By  this  term  is  understood  such 
declarations  as  are  made  by  a  dying  person,  who  believes 
that  he  is  in  actual  danger  of  death,  and  that  his  recovery 
is  impossible.  Such  declarations  are  received  in  evidence 
without  being  sworn  to.  The  law  presumes  that  decla- 
rations made  at  so  solemn  a  crisis  as  at  a  dying  moment 
must  be  sincere.  They  may  not,  however,  necessarily  be 
true,  although  sincere — i.  c,  believed  in,  at  the  time,  by  the 
deceased.     Dr.  Taylor  quotes  an  instance  of  a  dying  woman 


EXPERT    EVIDENCE. 


27 


in  St.  Thomas'  Hospital  who  accused  a  man  of  assaulting 
her.  He  was  found  guilty  and  executed.  A  year  after  the 
execution  his  innocence  was  established,  the  real  murderers 
having  been  discovered.  These  declarations,  moreover, 
must  relate  to  the  actual  circumstances  of  the  death,  and 
to  nothing  else. 

A  magistrate  or  other  official  authorized  to  take  deposi- 
tion in  important  cases,  if  such  can  be  had,  is  the  proper 
person  to  take  down  dying  declarations,  the  physician  in 
attendance  merely  giving  opinion  as  to  the  hopelessness  of 
the  case  and  the  soundness  of  the  person's  mind.  In  the 
absence  of  an  official,  the  medical  man  is  the  best  substitute, 
and  he  should  content  himself  by  simply  writing  down  the 
exact  words  of  the  dying  person,  without  adding  his  own 
interpretation  of  them.  If  possible,  the  dying  person  should 
sign  the  declaration  after  having  it  read  over. 


CHAPTER    II. 

PHENOMENA  AND  SIGNS  OF  DEATH. 

Among  the  numerous  and  diversified  cases  claiming 
medico-legal  attention,  perhaps  the  most  frequent  are  those  of 
violent  death.  A  knowledge  of  the  Signs  of  Death  becomes 
of  the  utmost  importance,  since  cases  not  infrequently  pre- 
sent themselves  in  which  there  is  considerable  doubt  and 
uncertainty  as  to  the  reality  of  the  death. 

For  a  proper  comprehension  of  this  subject,  attention 
should  first  be  directed  to  the  distinction  between  molecular 
and  somatic  death.  By  the  former  term  is  to  be  understood 
the  incessant  disintegration  of  tissue  which  is  going  on  in 
the  body  during  the  active  processes  of  Hfe  ;  the  waste  of 
material  thus  produced  being  compensated  by  the  repara- 
tion. In  youth,  the  supply  is  in  excess  of  the  waste,  and 
growth  is  the  result ;  in  advanced  age,  the  reverse  is  the 
case.  Somatic  death  is  the  cessation  of  all  the  vital  func- 
tions of  the  body,  or  the  death  of  the  whole  body.  The 
latter  is  the  popular  idea  of  death,  and  the  time  when  it 
takes  place  is  generally  recognizable.  The  precise  period 
when  universal  molecular  death  occurs  cannot  be  accurately 
determined.  No  doubt,  molecular  life  may  continue  some 
time  after  somatic  death,  as  is  evidenced  by  post-mortem 
temperature  and  muscular  irritability,  by  the  post-mortem 
beating  of  the  heart,  and  by  certain  acts  of  nutrition  and 
secretion. 

Although  the  outlets  of  human  life  are  so  numerous  and 
varied,  and  the  phenomena  of  death  are  diversified,  the  im- 

28 


PHENOMENA    AND    SIGNS    OF    DEATH.  29 

or  actual  cause  must  in  every  instance  be  referred 
to  an  arrest  of  the  function  of  one  or  other  of  the  three  great 
centers  of  life — the  heart,  the  lungs,  and  the  brain.  And 
so  intimately  are  the  functions  of  these  three  "centers" 
connected  together,  that  when  one  ceases  to  act,  the  actions 
of  the  others  speedily  cease.  Each  one  of  these  three  vari- 
eties has  its  own  special  phenomena  or  signs  ;  and  each 
exhibits  its  own  peculiar  or  characteristic  post-mortem 
appearances.  The  following  is  Bichat's  classification:  (i) 
death  beginning  at  the  brain,  (2)  death  beginning  at  the 
heart,  and  (3)  death  beginning  at  the  lungs. 

I.  Death  Beginning  at  the  Brain — Coma.  Symptoms. 
— Stupor,  more  or  less  profound  ;  insensibility  to  external 
impressions  ;  loss  of  consciousness  ;  breathing  slow,  ster- 
torous, and  irregular ;  respiration  gradually  faihng,  and 
ceases  as  the  medulla  oblongata  begins  to  be  affected. 
The  chest  ceases  to  expand  ;  the  blood  is  no  longer  aerated ; 
the  pulmonaiy  circulation  is  arrested  ;  the  lungs  cease  to 
act,  and  finally  the  heart's  pulsations  are  brought  to  a 
stop. 

Post-mortem  Appearances. — (i)  Effusion  of  blood  or  serum 
in  the  brain  or  cavities,  caused  by  [ci)  apoplexy,  {U)  rupture 
of  vessels  from  injury  or  fracture  of  the  skull,  or  in  disease 
of  the  arteries,  under  excitement.  (2)  Pressure  caused  by 
{a)  embolism,  {U)  abscess,  tumor,  or  other  organic  distur- 
bance;  {c)  congestion  of  the  vessels  of  the  brain.  (3)  Con- 
cussion from  a  blow  or  fall. 

II.  Death   Beginning   at  the   Heart — Syncope. — The 

heart  may  cease  to  act  from  two  distinct  causes  :  (i)  from 
a  deficiency  in  the  quantity  of  blood — its  normal  stimulant 


30  MEDICAL   JURISPRUDENCE. 

(anemia) ;  and  (2)  from  a  defect  in  the  quality  of  the  blood, 
or  from  a  loss  of  heart  power  {asthenia). 

Anemia  is  produced  by  sudden  loss  of  blood  in  disease, 
as  in  rupture  of  an  aneurysm  ;  uterine  and  other  hemor- 
rhage ;  or  by  violence,  as  from  wounds  of  heart  and  large 
vessels,  causing  fatal  hemorrhage. 

Symptoms. — Paleness  of  face  ;  lividity  of  lips  ;  vertigo  ; 
cold  sweat ;  slow,  weak,  and  fluttering  pulse  ;  gradual  insen- 
sibility. There  may  also  be  nausea  and  vomiting,  halluci- 
nations, delirium,  jactitations,  irregular  breathing,  sighing, 
and  convulsions  before  death.  The  nervous  symptoms  are 
due  to  want  of  brain  power,  in  consequence  of  a  deficient 
supply  of  blood. 

Post-mortem  Appearances. — Heart  contracted  and  empty 
( if  inspected  early).  If  life  has  been  protracted  for  several 
hours,  a  heart 'tlot  may  be  found.  ,  General  paleness  of  the 
organs  and  tissues.    ''  '     i-.m       -i    :"■■ 

Asthenia. — Here,  the  cause  of  the  cessation  of  the  heart's 
action  is  either  a  defect  in  the  quality  of  the  blood  or  some 
disorder  of  the  organs  producing  a  loss  of  heart  power  :  (i) 
by  disease,  as  {a)  various  cardiac  disorders^  such  as  fatty 
degeneration,  diseases  of  the  valves,  etc.;  ((5)  all  exhausting 
diseases,  as  phthisis,  cholera,  cancer,  etc.;  (2)  starvation; 
(3)  certain  injuries,  as  blows  on  epigastrium ;  (4)  certain 
poisons.  Cases  of  heart  failure  are-  popularly  termed /«r- 
alysis  of  the  heart. 

Symptoms. — Coldness  of  hands  and  feet ;  lividity  of  lips, 
fingers,  toes,  nose,  and  ears  ;  extreme  muscular  weakness  ; 
feeble  pulse  ;  sense  and  intellect  not  affected,  but  preserved 
to  the  last.  This  latter  is  well  seen  in  the  collapse  of 
Asiatic  cholera. 

Post-mortem  Appearances. — The  heart  not  contracted  ;  its 


DEATH    BEGINNING    AT    THE    HEART — SYNCOPE.  3  I 

cavities  contain  more  or  less  blood,  or  else  are  dilated  and 
flabby.  Blood  in  all  large  vessels,  but  no  congestion  of 
lungs  or  brain. 

III.  Death  Beginning  in  the  Lungs  —  Apnea — (As- 
phyxia).— Respiration  may  be  arrested  (i)  by  any  mechan- 
ical impediment  to  the  ingress  of  air  into  the  lungs,  as  (a) 
pressure  of  the  thorax  ;  (^d)  tetanic  spasm  of  the  muscles 
of  respiration  ;  {c)  paralysis  of  the  pneumogastric  or 
phrenic  nerves ;  [d")  exhaustion  of  muscular  power ;  (e) 
foreign  bodies  in  the  air  passages  ;  (/)  compression  of  the 
throat ;  (^)  suffocation  ;  (//)  drowning.  (2)  By  disease,  as 
pneumonia,  phthisis,  etc.,  spasm  of  the  glottis,  edema  of 
the  glottis,  phaiyngeal  abscess,  embolism  of  the  pulmonaiy 
artery,  and  the  accumulation  of  serum,  blood,  or  pus  in  the 
pleural  cavities.  (Strictly  speaking,  most  of  these  diseases 
cause  death  through  mechanical  interference  with  breath- 
ing.) 

Symptoms. — Great  dyspnea,  lividity  of  the  face,  loss  of 
consciousness,  vertigo,  and  occasionally  convulsions. 

Post-mortem  Appearances. — The  right  side  of  the  heart 
and  the  whole  venous  system  are  usually  filled  with  dark 
blood  ;  the  left  side,  together  with  the  arteries,  is  generally 
empty.  Cases  are,  however,  reported  where  the  right  cavi- 
ties of  the  heart  were  found  empty.  The  lungs  themselves 
are  nearly  always  gorged  with  dark  blood  ;  but  there  are 
some  exceptions  to  this,  which  will  be  noticed  hereafter. 

By  keeping  in  mind  the  foregoing  varieties  of  somatic 
death,  together  with  the  characteristic  post-mortem  appear- 
ances attendant  on  each,  the  examiner  will  be  considerably 
aided  in  arriving  at  a  definite  conclusion  as  to  the  real  cause 
of  death  in  any  particular  case. 


32  MEDICAL   JURISPRUDENCE. 

In  every  inquest  over  a  dead  body  five  important  ques- 
tions will  present  themselves  for  solution  :  (i)  The  reality  of 
the  death.  (2)  The  cause  of  the  death.  (3)  Was  the  death 
instantaneous,  sudden,  or  was  the  death  agony  prolonged? 
(4)  The  time  that  has  elapsed  since  the  death.  (5)  In  the 
case  of  the  body  of  a  new-born  infant — Was  it  born  alive  ? 

The  first  of  th'ese  questions  comprises  the  phejiomena 
and  signs  of  death.  How  can  we  distinguish  a  case  of  real 
from  one  of  apparent  death  ?  In  the  great  majority  of  in- 
stances, of  course,  there  is  no  practical  difficulty;  but  ex- 
ceptional cases  do,  at  times,  present  themselves  in  persons 
recently  dead,  where  the  corpse  still  retains  so  much  the 
appearance  of  life  as  to  occasion  some  doubts  about  the 
reality  of  dissolution.  The  natural  horror  of  being  buried 
alive  also  suggests  the  most  scrupulous  caution  in  the 
matter,  although  we  rarely,  if  ever,  hear  of  cases  of  pre- 
mature burial  in  civilized  countries  ;  yet  instances  are  not 
wanting  to  show  that  such  may  have  actually  occurred  in 
places  where  a  fatal  pestilence  has  prevailed  to  such  a  de- 
gree as  to  produce  a  panic  and  demoralize  the  community. 
Dr.  Tidy  reports  that  Nussbaum  states  "that  he  believes 
many  to  have  been  buried  during  the  war  (Franco-German) 
that  were  not  really  dead,  but  merely  suffering  from  an 
extreme  lethargy  arising  from  loss  of  blood,  exhaustion, 
hunger,  cold  and  fear." 

The  following  may  be  regarded  as  the  Signs  of  Death ; 

but  no  single  sign  should  be  relied  upon  exclusively: 

I.  The  Complete  and  Continuous  Cessation  of  the  Func- 
tions of  Circulation  and  Respiration. — In  some  cases  of 
apparent   death  —  syncope,    trance,   catalepsy  —  these   two 


SIGNS    OF    DEATH.  33 

functions  seem  to  be  suspended  for  a  time ;  but  the  sus- 
pension is  apparent,  not  absolute.  The  absence  of  the 
pulse  at  the  wrist  is  no  criterion  of  the  suspension  of  the 
circulation,  as  this  may  be  going  on  so  feebly  as  only  to  be 
detected  by  a  very  close  stethoscopic  examination  of  the 
heart,  which  should  never  be  omitted  in  cases  of  doubt. 
The  condition  of  both  the  circulation  and  respiration,  in 
such  cases  of  apparent  death,  simply  resembles  that  of 
certain  animals  in  the  state  of  hibernation.  Thus,  M. 
Bouchut  informs  us  that  in  the  marmot  the  heart  beats 
during  its  state  of  activity  amount  to  80  or  90  a  minute, 
but  are  reduced  to  8  or  9  very  feeble  pulsations  during 
the  period  of  hibernation.  Instances  are  recorded  (like 
that  of  Colonel  Townshend,  by  Dr.  Cheyne)  of  a  vol- 
untary suspension  of  the  heart's  action  ;  but  as  these 
cases  occurred  many  years  ago,  before  the  discovery  of 
auscultation,  it  is,  we  think,  highly  probable  that  the  sus- 
pension was  not  absolute,  but  only  reduced  down  to  so  fine 
a  point  as  to  have  escaped  notice.  It  is  certainly  contrary 
to  all  scientific  reasoning  that  life  can  continue  many  min- 
utes without  the  circulation  of  the  blood ;  therefore  we 
need  have  no  hesitation  as  to  the  reality  of  death,  if  we 
can  be  positively  certain  of  the  continuous  arrest  of  this 
function,  say  for  one  hour.  The  converse  of  this  proposi- 
tion, however,  is  not  always  true  ;  that  is,  the  pulsation 
of  the  heart  may  continue  for  a  brief  time  after  actual 
death.  Duval  mentions  having  seen  the  heart  of  a  criminal 
beat  fifteen  times  after  decapitation,  the  left  auricle  pulsat- 
ing for  an  hour.  This  is  corroborated  by  some  obser- 
vations made  in  Paris  upon  the  body  of  a  decapitated 
criminal.  This  same  phenomenon,  as  is  well  known,  is 
witnessed  still  more  remarkably  in  the  heart  of  the  stur- 
3 


34  .  MEDICAL   JURISPRUDENCE. 

geon,  frog,  and  snapping  turtle,  which  will  continue  to 
pulsate  many  hours  after  removal  from  the  body.  This 
fact,  as  also  the  post-mortem  contraction  of  the  muscles 
under  galvanic  stimulus,  proves  the  continuance  of  molec- 
ular life  after  somatic  death. 

This  question  of  the  beating  of  the  heart  in  a  still-born 
infant  being  regarded  as  a  valid  sign  of  life,  will  be  dis- 
cussed later. 

The  same  remarks  may  be  made  with  regard  to  the 
function  of  respiration.  The  absolute  and  contimwiis  cessa- 
tion of  breathing  —  say  one  hour  —  may  be  regarded  as  a 
positive  sign  of  death.  In  cases  of  apparent  death,  as 
already  remarked,  this  function  may  apparently  be  sus- 
pended ;  but  it  is  in  reahty  only  reduced  down  to  its  mini- 
mum of  action.  This  likewise  should  be  verified  by  care- 
ful and  repeated  auscultation.  The  common  practice  of 
holding  a  feather  near  the  nose  or  mouth  may  serve,  by  its 
movements,  to  indicate  breathing.  So  likewise  the  deposit 
of  moisture  on  a  mirror,  held  in  the  same  position,  will  in- 
dicate the  feeblest  respiration.  But  neither  of  these  is  an 
absolutely  positive  sign,  since  they  both  fail  when  applied 
in  the  case  of  the  hibernating  animal  which  we  know  is 
really  alive. 

Another  method  is  to  place  a  small  vessel  containing 
mercuiy  on  the  thorax  of  the  body  lying  face  upward  ;  the 
slightest  respiratory  action  will  be  indicated  by  the  move- 
ments of  a  reflected  image,  made  to  fall  on  the  surface  of 
the  bright  metal. 

It  may  be  remarked  that  in  cases  of  trance,  catalepsy, 
and  other  instances  of  suspended  animation,  the  body  never 
exhibits  either  the  pallor  or  coldness  of  real  death.  More- 
over, if  a  ligature  be  applied  around  the  finger  of  a  corpse. 


SIGNS    OF    DEATH.  35 

no  change  of  color  will  be  observed  ;  but  if  the  experiment 
be  made  on  a  living  body,  the  tip  of  the  finger  will  become 
of  a  red  or  purple  color,  in  consequence  of  the  arrest  of  the 
capillary  circulation  at  that  spot.  A  ligature  around  the 
wrist  will  cause  swelling  of  the  dorsal  veins  of  the  hand  if 
there  is  any  life  (B.  W.  Richardson).  The  most  powerful 
counter-irritants,  e.  g.,  oil  of  mustard,  cantharides,  etc.,  will 
produce  no  redness  or  blisters  on  the  dead  body. 

II.  The  Condition  of  the  Eyes. — The  changes  pro- 
duced in  the  eyes  by  death  are:  (i)  The  entire  loss  of 
sensibility  to  light ;  the  pupils  neither  contract  nor  expand 
under  this  stimulus.  This,  however,  is  not  a  positive  sign, 
since  the  same  insensibility  to  light  is  witnessed  during  life 
in  certain  cerebral  affections,  and  is  also  the  result  of  the 
action  of  certain  poisons.  (2)  The  action  of  atropin  and 
other  mydriatics  to  expand  the  pupil,  and  of  calabar  bean 
(eserin)  to  contract  it  during  life,  is  lost  within  a  few  hours 
after  death.  These  agents  do,  however,  produce  a  visible 
effect  if  applied  veiy  soon  after  the  cessation  of  life,  and 
before  the  body  has  become  cold,  and  all  muscular  irritabil- 
ity has  ceased.  (3)  The  cornea  loses  its  transparency,  and 
the  eye-ball  its  elasticity,  very  speedily  after  dissolution. 
But  these  conditions  may  likewise  exist  before  death,  as  the 
results  of  disease.  In  apparent  death,  the  cornea  retains  its 
translucency  ;  the  papilla  of  the  retina  is  of  a  rose-red  color ; 
and  the  fundus  of  the  eye  is  furrowed  by  the  arteries  and 
veins  of  the  retina.  At  the  moment  of  death,  the  papilla 
of  the  optic  nerve  becomes  quite  pale,  and  the  central  artery 
of  the  retina  disappears.  It  should  also  be  remarked  that 
the  eye  sometimes  retains  its  luster  after  death.  This  is 
seen  after  poisoning  by  hydrogen  cyanid  and  carbon  dioxid. 


36  MEDICAL   JURISPRUDENCE. 

III.  The  Pallor  of  the  Body. — This  sign  is  very  uni- 
form, though  not  without  some  exceptions,  as  in  the  case 
of  persons  of  very  florid  complexions,  and  in  exceptional 
instances  where  the  cheeks  and  lips  retain  their  rosy  color 
for  some  days  after  death,  so  as  to  occasion  some  uncer- 
tainty as  to  the  actual  fact  of  death,  in  the  minds  of  relatives. 
It  is  also  wanting  in  cases  of  death  from  yellow  fever  and 
jaundice ;  moreover,  the  red,  inflammatory  zones  around 
ulcers  and  burns,  tattoo  marks,  the  spots  of  purpura,  and 
ecchymoses  or  bruises  do  not  disappear  after  death.  It 
must  also  not  be  forgotten  that  a  death-like  pallor  is  seen 
in  cases  of  swooning,  and  sometimes  in  the  cold  stage  of 
ague,  and  in  collapse. 


IV.  Loss  of  Animal  Heat. —  During  life,  the  animal 
body  possesses  the  wonderful  faculty  of  maintaining  its  own 
normal  temperature  (about  98°  F.)  independently  of  the 
surrounding  medium.  This  is  effected  as  the  result  of  cer- 
tain vital  processes.  At  the  moment  of  death  there  is  a 
slight  rise  in  temperature ;  but  a  decline  begins  soon  and 
continues  until  the  body  acquires  the  temperature  of  the 
surrounding  medium,  precisely  as  any  other  warm  body 
parts  with  its  excess  of  heat  to  the  surrounding  medium. 
It  never  gets  lower  than  this  medium,  unless  the  tempera- 
ture of  the  latter  becomes  suddenly  increased  ;  then,  for  a 
while,  the  body  will  be  really  cooler  than  the  temperature 
of  the  atmosphere.  The  sense  of  touch  does  not  convey 
an  accurate  idea  of  the  actual  coldness  of  the  dead  body, 
since  the  conducting  power  of  the  tissues  varies  materially. 
The  direct  application  of  the  thermometer  to  the  body  is 
the  only  safe  method.     If  the  temperature  in  the  mouth  is 


LOSS    OF   ANIMAL    HEAT.  37 

lower  than  the  surrounding  atmosphere,  it  is  a  strong  pre- 
sumptive sign  of  death  (Richardson). 

The  time  in  which  the  coohng  of  the  body  is  completed  is 
stated  to  be,  on  the  average,  from  fifteen  to  twenty-four 
hours.  Prof  Casper  makes  it  from  eight  to  twelve  hours. 
It  varies  considerably,  according  to  the  condition  of  the 
body  itself,  according  to  the  medium  in  which  it  is  kept 
after  death,  and  also  according  to  the  manner  of  death. 
Fat  bodies  retain  heat  longer  than  lean  ones  ;  the  bodies  of 
young  children  and  of  old  persons  cool  more  rapidly  than 
those  of  adults  ;  while  the  bodies  of  those  who  die  from 
suffocation,  electric  shocks,  and  from  certain  other  diseases, 
e.  g.,  yellow  fever  and  tetanus,  retain  heat  longer  than 
others. 

The  body,  of  course,  cools  more  rapidly  if  exposed  to  the 
air  unclothed  than  if  covered  up  in  the  bed-cloths  ;  also  in 
a  large  airy  apartment,  than  in  a  small,  close  room.  It 
will  cool  more  rapidly  in  water  than  in  the  air.  In  death 
from  chronic  wasting  diseases,  and  also  in  cholera,  the  body 
cools  very  rapidly.  According  to  Taylor,  loss  of  blood 
does  not  hasten  the  cooling  process. 

The  interior  of  the  body  retains  its  heat  considerably 
longer  than  the  surface,  so  that  if  an  autopsy  be  made 
within  twenty-four  hours  after  death,  even  when  its  exterior 
feels  perfectly  cold,  the  abdominal  viscera  may  exhibit  a 
temperature  twenty  degrees,  or  more,  higher  than  that  of 
the  surface. 

It  should  not  be  forgotten  that  coldness  of  the  body  is 
a  frequent  phenomenon  of  sickness  ;  it  is  witnessed  in  hys- 
teria and  ague,  also  in  cholera.  Its  value  as  a  sign  of 
death  consists  in  the  fact  that  it  is  progressive  and  con- 
tinuous, while  the  coldness  of  disease  is  sudden  and    not 


38  MEDICAL   JURISPRUDENCE. 

permanent.  Hence  the  degree  of  coldness  of  the  body 
will  often  be  a  good  indication  of  the  time  that  has  elap-sed 
since  death. 

Another  fact  to  be  noticed  is  that  the  rate  of  cooling 
after  death,  although  progressive,  is  not  uniform ;  it  is 
much  more  rapid  during  the  earlier  hours  than  later.  Dr. 
Goodhart's  observations  show  that  during  the  first  three 
hours  after  death  the  loss  of  heat  per  hour  amounted,  in 
the  robust,  to  3.5°,  in  the  emaciated,  to  4.7°  ;  while  when 
the  body  was  nearly  cold,  the  loss  per  hour  was,  in  the 
emaciated,  1.12°,  and  in  the  robust,  1.26°. 

A  marked  and  prolonged  rise  of  temperature  after  death 
is  observed  in  some  cases.  This  exceptional  condition 
occurs  occasionally  in  the  bodies  of  those  who  have  died 
from  yellow  fever,  cholera,  tetanus,  smallpox,  and  some  other 
acute  disorders.  The  exact  cause  of  this  singular  rise  of 
temperature  (^post-mortem  caloricit)>)  is  not  clearly  under- 
stood. In  some  instances  the  increase  of  heat  has  amounted 
to  9°  F.  Dr.  Davy  records  a  post-mortem  temperature 
of  113°  F.  in  the  pericardium.  We  may  suppose  that  in 
these  cases  molecular  life  has  continued  after  the  cessation 
of  somatic  life.  We  know  that  muscular  irritability  and 
contractility  continue  for  many  hours  (under  certain  condi- 
tions) after  death,  and  this  undoubtedly  indicates  the  con- 
tinuance of  their  molecular  activity  up  to  a  certain  point. 

The  injection  of  a  few  drops  of  solution  of  ammonium 
hydroxid  hypodermically  leaves  no  mark  in  actual  death, 
but  occasions  a  dark  spot  in  apparent  death. 

V.  Cadaveric  Rigidity,  or  Rigor  Mortis.  —  By  this  is 
understood  the  stiffening  of  the  body  so  generally  observed 
after   death.      It  usually   occurs   simultaneously    with    the 


CADAVERIC    RIGIDITV.  39 

cooling  process.  It  may  be  stated  to  be  universal  in  death 
from  any  cause,  and  to  be  present  in  the  lower  animals  as 
well  as  in  man.  In  some  instances,  however,  it  is  so  tran- 
sient as  to  escape  notice.  It  comes  on  at  very  variable 
periods,  from  a  few  moments  to  eighteen  to  twenty  hours 
after  death.  This  remarkable  variation  in  its  approach  is 
chiefly  due  to  the  condition  of  the  muscular  system  at  the 
time  of  death.  Its  duration  is  equally  variable,  lasting  from 
a  few  moments  to  many  hours,  or  even  weeks.  After  the 
rigidity  passes  off  the  body  regains  its  original  pliancy  and 
decomposition  immediately  commences.  As  a  general  rule, 
the  putrefaction  of  the  body  is  retarded  until  the  rigor  mor- 
tis has  passed  off. 

It  commences  usually  in  the  muscles  of  the  eye,  which 
often  become  rigid  within  a  few  minutes  after  death  ;  next 
in  the  muscles  of  the  neck  and  lower  jaw;  then  in  the  chest 
and  upper  extremities ;  afterward  in  the  muscles  of  the  ab- 
domen and  lower  limbs.  The  rigidity  generally  passes  off 
in  the  same  order;  thus,  the  legs  frequently  remain  quite 
rigid  after  the  upper  portion  of  the  body  has  regained  its 
suppleness. 

The  seat  of  the  rigor  mortis  is  undoubtedly  the  muscular 
system.  That  it  is  in  no  wise  dependent  upon  the  nervous 
system  is  proved  by  the  fact  that  all  the  nerves  supplying  a 
muscle  may  be  divided  and  yet  the  muscle  will  continue 
to  act,  contracting  under  the  galvanic  stimulus.  But  re- 
sponse ceases  immediately  on  division  of  the  muscle.  Even 
the  removal  of  the  brain  and  spinal  marrow  has  no  effect  in 
preventing  the  muscular  contraction.  Again,  the  muscles 
of  a  paralyzed  limb  become  equally  rigid  with  those  in 
sound  health.  The  cause  of  the  contraction  is  usually 
ascribed  to  the    coagulation    of  the    muscular   plasma,   a 


40  MEDICAL   JURISPRUDENCE. 

proteid  principle  possessing  the  property  of  coagulation  to 
a  high  degree.  The  reaction  of  a  muscle  in  rigor  mortis  is 
acid  (reddens  blue  Htmus);  but  it  becomes  alkahne  after  the 
rigidity  passes  off  While  in  the  state  of  rigor  mortis,  the 
muscle  is  opaque  ;  before  this,  it  is  partially  translucent. 
Brown-Sequard  has  shown  that  a  current  of  arterial  blood 
will  restore  muscular  contractility  to  a  rigid  limb. 

The  duration  of  rigor  mortis  is  one  of  its  most  important 
features.  As  already  observed,  this  is  extremely  variable, 
although,  as  a  rule,  it  does  not  set  in  until  the  body  has 
begun  to  cool ;  still,  in  some  of  the  lower  animals,  and 
notably  in  birds,  it  often  manifests  itself  while  the  body  is 
yet  warm.  From  the  observations  of  Brown-Sequard  and 
others  it  appears  that  the  period  after  death  when  the  rigor 
mortis  manifests  itself,  together  with  its  duration,  is  depen- 
dent chiefly,  if  not  altogether,  upon  the  previous  degree 
of  muscular  exhaustion.  To  properly  understand  this,  it 
should  be  remembered  that  immediately  after  death  the 
muscles  are  in  a  state  of  complete  relaxation,  giving  to  the 
body  perfect  pliancy.  This  condition  may  last  for  so  brief 
a  space  of  time  as  not  to  be  noticed,  though  usually  it  con- 
tinues for  three  or  four  hours,  after  which  rigidity  com- 
mences. During  this  period  of  relaxation  the  muscles  have 
not  yet  lost  their  molecular  life,  so  that  they  will  respond 
to  galvanic  and  other  stimuli.  Hence,  although  the  con- 
traction of  a  muscle  by  electricity  is  no  positive  sign  of 
somatic  life,  still  it  will  enable  us  to  conclude  either  that  the 
person  is  yet  alive  or,  more  probably,  that  death  has  very 
recently  occurred.  The  cessation  of  all  muscular  con- 
tractility under  galvanic  stimulus  is  a  proof  not  only  of  the 
death  of  the  individual,  but  it  also  indicates  that  the  death 
w^as  not  very  recent — hardly  within  three  or  four  hours. 


CADAVERIC    RIGIDITY.  4 1 

So  long  as  the  muscles  retain  their  contractility,  the  rigor 
mortis  is  postponed. 

It  can  now  be  understood  that  whatever  produces  ex- 
haustion of  the  muscular  system  must  thereby  hasten  the 
approach  of  cadaveric  rigidity.  Thus,  in  death  from  ex- 
hausting diseases,  as  in  phthisis,  or  after  protracted  convul- 
sions, or  when  the  muscular  system  becomes  exhausted  by 
over-exertion  and  fatigue,  as  is  seen  in  over-driven  cattle, 
or  in  animals  hunted  in  the  chase,  the  rigor  mortis  shows 
itself  early,  and  lasts  but  a  short  time  ;  whereas,  if  death 
occurs  suddenly,  in  a  previously  healthy  person,  the  rigidity 
is  postponed  for  many  hours,  but  when  once  established  it 
continues  for  a  much  longer  period.  Thus,  according  to 
Brown -Sequard,  the  bodies  of  decapitated  healthy  criminals 
were  observed  not  to  become  rigid  until  after  the  lapse  of 
ten  to  twelve  hours,  and  the  rigidity  lasted  over  a  week, 
even  in  warm  weather.  An  experiment  of  the  above-named 
physiologist  very  satisfactorily  proves  this  statement.  Three 
dogs  of  equal  size  were  poisoned  with  strychnin  in  different 
doses.  One  took  two  grains,  and  died  almost  immediately. 
The  second  took  half  a  grain,  and  died  in  twelve  minutes. 
The  third  took  one  fourth  of  a  grain,  and  died,  after  pro- 
tracted convulsions,  in  twenty-one  minutes.  In  the  first 
animal,  whose  muscular  system  had  been  least  exhausted 
by  the  spasms,  rigor  mortis  did  not  set  in  before  the  lapse 
of  eight  hours,  and  the  duration  was  nineteen  to  twenty 
days.  In  the  second,  where  the  muscular  exhaustion  was 
greater,  the  rigidity  appeared  after  two  and  a  half  hours, 
and  lasted  five  days.  In  the  third,  in  which  the  muscular 
exhaustion  was  the  most  protracted,  the  rigor  mortis  was 
developed  as  early  as  thirty  minutes,  and  lasted  less  than  a 
day. 


42  MEDICAL   JURISPRUDENCE. 

It  has  been  supposed  by  some  that  the  rigor  mortis  does 
not  occur  in  the  bodies  of  persons  killed  by  lightning ;  ex- 
perience shows  this  to  be  a  mistake.  It  is  also  stated  to  be 
absent  in  those  killed  by  snake-poison,  in  whom  likewise 
the  blood  remains  fluid.  Neither  is  it  interfered  with  by 
the  previous  loss  of  blood  by  hemorrhage.  It  is,  however, 
dependent  on  temperature,  at  least  so  far  as  regards  the 
duration,  which  is  shortened  by  heat  and  prolonged  by  cold. 
Bodies  submerged  in  cold  water  retain  their  rigidity  for  a 
considerable  length  of  time. 

When  a  joint  or  articulation  stiffened  by  complete  rigor 
mortis  is  forcibly  bent,  the  rigidity  is  destroyed.  If,  how- 
ever, the  rigidity  is  incomplete,  it  will  be  resumed  after- 
ward. This  may  serve  to  distinguish  real  death  from 
certain  cases  of  catalepsy,  tetanus,  and  hysteria,  accom- 
panied by  rigidity.  In  all  these  latter  cases  the  stiffness 
will  return  on  removal  of  the  opposing  force. 

Cadaveric  rigidity  is  not  so  strong  as  voluntary  muscular 
contraction.  As  a  rule  the  flexors  are  more  affected  than 
the  extensors,  so  that  the  limbs  are  generally  found  to  be 
slightly  bent  after  death. 

The  fact  that  the  involuntary  muscles  are  likewise  subject 
to  rigor  mortis  should  not  be  lost  sight  of,  as  it  might  lead 
to  an  error  as  to  the  true  pathological  state  of  an  organ,  on 
making  an  autopsy.  The  heart,  for  instance,  may  be  found 
very  firmly  contracted  after  death  by  rigor  mortis  ;  this 
might  be  mistaken,  by  the  inexperienced,  for  a  true  con- 
traction of  the  organ,  the  result  of  previous  disease. 

Closely  connected  with  rigor  mortis,  if  not  indeed  a  modi- 
fication of  this  very  state,  is  the  condition  described  as 
cadaveric  spasm.  This  is  exhibited  in  the  bodies  of  persons 
who  have  died  by  sudden  and  violent  deaths,  in  whom  there 


CADAVERIC    RIGIDITY.  43 

seems  to  be  present  a  powerful  will-power  just  prior  to  the 
death,  and  producing  strong  muscular  contraction  at  the 
moment  of  dissolution.  This  spasmodic  contraction,  more- 
over, appears  to  pass  at  once,  after  death,  into  the  usual 
rigor  mortis.  The  best  illustrations  of  this  peculiar  condi- 
tion are  afforded  in  those  cases  of  determined  suicides  who 
have  taken  their  lives  by  shooting  themselves  with  a  pistol. 
Very  commonly,  in  such  cases,  the  weapon  is  found  so 
tightly  grasped  in  the  dead  hand  that  considerable  force  is 
required  to  remove  it.  The  same  condition  is  sometimes 
witnessed  in  the  bodies  of  drowned  persons  ;  fragments  of 
wood,  grass  and  weeds,  or .  other  objects  which  had  been 
convulsively  seized  in  the  water  before  death,  bein^  found 
tightly  grasped  in  their  hands  ;  and  where  two  persons  have 
perished  together  by  drowning,  it  is  not  uncommon  to  find 
them,  after  death,  convulsively  clasped  in  each  other's  arms. 
To  a  similar  reason,  doubtless,  is  to  be  ascribed  the  singular 
and  striking  postures  sometimes  exhibited  by  the  bodies  of 
soldiers  killed  in  battle.  Thus,  the  attitude  of  one  is  de- 
scribed as  "  resting  on  one  knee,  with  the  arms  extended, 
in  the  act  of  taking  aim  ;  the  brow  compressed,  the  lips 
clenched  —  the  very  expression  of  firing  at  an  enemy 
stamped  upon  his  face,  and  fixed  there  by  death.  A  ball 
had  struck  this  man  in  the  neck.  Another  was  lying  on 
his  back,  with  the  same  expression,  with  his  arms  raised  in 
a  similar  attitude,  the  Minie  musket  still  grasped  in  his 
hands,  undischarged  "  (Taylor). 


VI.  Cadaveric  Lividity,  or  Suggillation. — This  term 
is  applied  to  those  livid  or  violet-colored  patches  or  dis- 
colorations  which  are  observed  upon  the  body  at  variable 


44  MEDICAL   JURISPRUDENCE. 

periods  after  death,  usually  after  several  hours.  It  is  the 
result  of  the  settling  of  the  blood  in  the  capillaries  by  gravi- 
tation. Hence,  it  is  noticed  in  the  most  dependent  parts  of 
the  body,  such  as  (supposing  it  to  be  lying  on  the  back)  the 
back,  under  surface  of  the  neck,  calves  of  the  legs  and  under 
portions  of  the  thighs.  These  patches,  at  first  isolated,  grad- 
ually increase  in  size  and  coalesce,  so  as  to  cover  a  large 
surface  of  the  body.  Cadaveric  lividity  is  an  unqestionable 
"  sign  "  of  death.  It  makes  its  appearance  sometimes  much 
earlier  than  at  others,  and  for  this  variation  no  very  satisfac- 
toiy  reason  can  be  assigned. 

The  most  important  point  connected  with  cadaveric 
lividity*  is  not  to  confound  it  with  ecchymosis  or  bruising, 
to  which  it  bears  a  considerable  resemblance.  Several 
cases  are  recorded  where  a  body  has  been  found  covered 
with  these  death -spots,  and  the  mistake  has  been  made  of 
supposing  them  to  be  bruises  and  consequently  attributing 
the  death  to  violence  inflicted  during  life.  The  medical 
examiner  should  be  particularly  cautious  not  to  confound 
them.  Fortunately,  a  very  simple  test  will  settle  the  ques- 
tion. If  the  scalpel  be  drawn  through  a  suggillation,  no 
blood  will  flow;  the  most  that  will  be  obsei-ved  will  be  a 
few  bloody  points  or  specks,  arising  from  the  division  of 
small  veins  of  the  skin.  If,  however,  the  patch  be  ecchy- 
mosis (where  the  effused  blood  has  been  infiltrated  into  the 
cellular  tissue),  the  incision  will  either  be  followed  by  a  flow 
of  blood  or  else  a  coagulum  will  be  seen.  Moreover,  while 
the  ecchymosis  is  sometimes  raised  above  the  level  of  the 
surrounding  skin,  the  cadaveric  stain  never  is.  The  change 
of  color  following  an  ecchymosis — from  purple  to  green  and 
yellow — will  also  serve  as  a  ground  of  distinction.  These 
cadaveric  spots  are  not  affected  by  age,  sex  or  constitution, 


CADAVERIC    LIVIDITY.  45 

and  they  follow  upon  all  kinds  of  death,  not  excepting  that 
caused  by  hemorrhage. 

Suggillation  takes  place  in  the  internal  organs  as  well  as 
upon  the  surface  of  the  body,  producing  in  the  former 
appearances  strongly  resembling  true  congestion  and  in- 
flammation, for  which  they  are,  without  doubt,  frequently 
mistaken  by  the  inexperienced,  and  as  it  may  be  a  matter 
of  considerable  consequence  in  a  post-mortem  examination 
not  to  confound  these  two  conditions,  the  examiner  should 
be  very  cautious  as  to  his  pathological  inferences.  These 
internal  suggillations  are  also  termed  hypostatic  congestions  ; 
they  appear  chiefly  in  the  lungs,  brain,  kidneys  and  intes- 
tines. The  fact  that  they  invariably  occur  in  the  most 
dependent  portions  of  these  organs  should  be  suggestive  of 
their  true  origin,  since  a  real  congestion  or  inflammation 
exhibits  itself  either  throughout  the  whole  organ  or  else 
upon  its  upper  surface  equally  with  the  lower  one ;  cer- 
tainly it  is  not  confined  exclusively  to  the  under  portion,  as 
is  the  suggillation.  The  observer  should  be  careful  not  to 
be  misled  by  finding  suggillation  on  the  upper  part  of  an 
organ,  as  it  may  have  been  that  the  body  has  been  recently 
turned  over.  When  it  occurs  in  the  intestines,  it  may 
readily  be  distinguished  from  true  inflammation  by  simply 
lifting  up  several  folds  of  the  bowels,  when  the  horizontal 
line  which  previously  had  marked  the  hypostatic  settling 
of  the  blood  becomes  immediately  broken  and  disjointed, 
whereas,  if  it  had  been  a  real  congestion  or  inflammation, 
the  redness  would  have  involved  the  whole  circumference 
of  the  intestines  and  there  would  have  been  no  broken  line 
of  separation. 

In  the  brain,  hypostatic  congestion  might  be  mistaken, 
by  the  inexperienced,  for  one  form  of  apoplexy ;  and  in  the 


46  MEDICAL   JURISPRUDENCE. 

spinal  cord,  it  might  be  confounded  with  spinal  meningitis. 
In  the  heart,  true  suggillation  is  not  believed  to  occur ;  but 
this  is  replaced  by  the  formation  of  post-mortem  clots. 

VII.  Putrefaction. — This  is  usually  regarded  as  the 
most  unequivocal  "  sign  "  of  death.  By  this  term  is  under- 
stood those  spontaneous  chemical  changes  undergone  by  all 
dead  animal  bodies  resulting  in  the  elimination  of  fetid  gases. 
The  period  after  death  when  putrefaction  first  manifests 
itself  varies  considerably,  being  dependent  upon  several  con- 
ditions, some  of  which  are  connected  with  the  body  itself 
and  others  extraneous  to  the  body. 

Among  the  conditions  inherent  to  the  body  itself  are  : 

1 .  Corpulence. — Fat  and  flabby  bodies  undergo  putrefac- 
tion more  speedily  than  thin  and  lean  ones,  doubtless  on 
account  of  the  preponderance  of  fluids  in  the  former. 

2.  Age  and  Sex. — For  the  same  reason,  the  bodies  of 
new-born  children  and  of  women  dying  in  child-bed  ( ac- 
cording to  Casper)  decompose  more  rapidly  than  others, 
especially  the  aged. 

3.  TJie  Manner  of  Death. — The  bodies  of  persons  dying 
of  diseases  in  which  the  vitality  of  the  blood  has  been 
impaired,  as  in  typhus  fever,  pyemia,  etc.,  undergo  rapid 
putrefaction  ;  also  after  death  from  certain  poisons,  and 
especially  gases,  illuminating  gas,  and  hydrogen  sulphid  ; 
also  from  suffocation  from  smoke,  and,  indeed,  from  suffo- 
cation generally.  Putrefaction  is  also  accelerated  in  bodies 
that  have  been  much  bruised  and  mangled  by  machinery, 
or  by  railway  and  other  accidents  ;  but  we  must  except 
those  cases  where  the  body  remains  protected  from  atmos- 
pheric influences,  as  when  buried  beneath  ruins,  etc.  On 
the  other  hand,  the  process  is  retarded  in  death  by  alcohol, 


PUTREFACTION.  47 

phosphorus,  sulphuric  acid,  arsenical  compounds,  and  some 
narcotic  poisons.  The  antiseptic  properties  of  alcohol  and 
arsenic  are  well  understood.  The  action  of  acids  is  a  direct 
retarding  influence  on  the  development  of  the  microbes 
causing  putrefaction.  Admitting  all  the  above  conditions, 
and  giving  them  due  allowance,  there  are  doubtless  other 
causes,  as  yet  unknown  to  us,  which  influence  the  rapidity 
of  putrefaction.  Casper  adduces  the  instances  of  four  men 
about  the  same  age  and  general  physique,  and  all  killed  at 
the  same  time  in  a  riot.  They  w^ere  buried  at  the  same  time, 
and  in  precisely  similar  coffins  and  graves  ;  yet  on  subse- 
quent examination,  the  extent  of  decomposition  was  found 
to  be  very  different  in  the  different  bodies. 

The  external  conditions  influencing  putrefaction  are  air, 
moisture,  and  temperature.  These  conditions  act  by  reason 
of  their  influence  on  the  development  of  microbes  to  which 
putrefaction  is  due.  Most  microbes  require  oxygen  for 
growth  and  multiplication  ;  all  require  heat  and  moisture. 
The  processes  for  preserving  perishable  articles,  such  as 
meats  and  fruits,  illustrate  these  principles.  The  influence 
of  air  is  not  limited  to  the  mere  supply  of  oxygen  ;  but  it 
modifies  putrefaction  according  to  the  amount  of  moisture 
it  contains.  For  this  reason  perfectly  dry  air,  such  at  that 
of  the  arid  deserts  of  Arabia  and  Africa,  by  its  rapid  desic- 
cating properties,  arrests  putrefaction,  the  body  speedily 
losing  its  fluids  by  evaporation  and  shriveling  up  into  a  sort 
of  mummy.  The  effects  of  an  entire  exclusion  of  air  in 
retarding  the  process  of  decomposition  in  a  human  body 
are  witnessed  in  the  burial  of  royal  personages  in  leaden 
coffins  hermetically  sealed,  and  these  afterward  enclosed  in 
marble  sarcophagi.  When  these  have  been  opened,  hun- 
dreds of  years  subsequently,  the  remains  have  been  found 


4^  MEDICAL   JURISPRUDENCE. 

preserved.  On  the  other  hand,  bodies  naked,  or  but 
slightly  clothed,  and  buried  in  pine  coffins,  which  soon 
decay,  and  in  shallow  graves  to  which  the  air  has  easy 
access,  will  undergo  very  speedy  decomposition.  The 
nature  of  the  soil  and  the  depth  of  the  grave  also  materiariy 
influence  this  process.  Thus,  a  loose,  sandy  soil  and  a 
shallow  grave  favor  it  by  the  ready  admission  of  air,  while 
soil  of  a  stiff,  clayey  nature  and  a  deep  grave  would  retard 
it,  for  the  opposite  reason.  From  recent  observations,  it 
has  been  ascertained  that  part  of  the  atmospheric  influence 
upon  decomposition  is  the  presence  of  the  microorganisms, 
termed  bacteria  or  bacilli,  which  float  in  such  myriads  in 
the  air,  and  which  find  their  peculiar  habitat  in  dead  animal 
matter. 

The  different  tissues  and  organs  of  the  body  undergo 
decomposition  in  proportion  to  the  amount  of  fluids  they 
contain.  In  this  respect  the  brain  of  the  young  infant  and 
the  eye  contrast  widely  with  the  bones  and  teeth.  The 
human  body  contains  about  eighty  per  cent,  of  fluids  ; 
hence  its  great  tendency  to  putrefy  after  death.  The 
bodies  of  drowned  persons  undergo  rapid  decomposition, 
unless  the  water  be  extremely  cold,  or  contains  substances 
with  antiseptic  properties  which  prevent  the  growth  of 
microbes.  Bodies  thrown  into  dung-heaps  and  cesspools 
speedily  putrefy.  If  a  body  be  completely  deprived  of  its 
fluids  by  drying,  putrefaction  is  arrested,  as  has  been  noted. 

The  influence  of  temperature  as  an  agent  in  putrefaction 
is  very  manifest.  The  temperature  most  favorable  to  this 
process  is  that  between  70°  and  100°  F.  It  commences, 
however,  as  low  as  50°  ;  but  it  is  completely  arrested  at 
32°,  below  which  the  body  becomes  frozen,  and  also  at 
212°,  at  which  point  all  microorganisms  are  killed.     An 


PUTREFACTION.  49 

animal  body  may  be  preserved  for  an  indefinite  period  if 
completely  frozen  in  snow  or  ice.  It  is  recorded  that  the 
body  of  a  Russian  nobleman  that  had  been  buried  in  the 
frozen  soil  of  Siberia,  on  being  exhumed  after  a  period  of 
ninety-two  years,  was  found  in  a  state  of  almost  perfect 
preservation. 

The  effect  of  temperature  in  the  process  of  putrefaction 
is  familiarly  shown  in  the  influence  of  the  seasons.  In 
summer  a  body  will  decompose  very  much  sooner  than  in 
winter — a  circiunstance  that  should  not  be  forgotten  when 
giving  an  opinion  respecting  the  date  of  death  in  an  un- 
known case.  According  to  Casper,  the  relative  rapidity 
of  decomposition  in  bodies  exposed  to  the  air,  kept  in  cold 
water,  and  buried  in  the  earth,  is  in  the  ratio  of  one,  two, 
and  eight ;  that  is,  putrefaction  advances  as  rapidly  in  one 
week  in  the  open  air  as  in  two  weeks  in  the  water  and  in 
eight  weeks  in  the  earth  (average). 

Dr.  Konig,  of  Hermannstadt,  has  reported  on  the  ap- 
pearance of  a  number  of  bodies  of  Hungarians  taken  from 
a  deep  pool  of  the  waters  of  the  Echoschacht  after  the 
lapse  of  forty  years.  They  were  in  a  state  of  perfect  pres- 
ervation, without  a  trace  of  decomposition  or  of  the  forma- 
tion of  adipocere.  The  internal  organs  were  of  the  con- 
sistence of  those  of  a  newly-deceased  corpse,  and  the  brain 
was  hard,  as  if  presei-ved  in  spirit.  In  the  interior  of  these 
bodies  a  large  amount  of  sodium  chlorid  was  found,  crys- 
tallized in  cubes,  deposited  on  the  organs,  and  which  had 
evidently  penetrated  into  the  bodies  from  without.  These 
crystals  were  found  even  within  the  perfectly  closed  peri- 
cardium and  adhering  to  the  heart. 

It  may  here  be  remarked  that  a  body  floating  near  the 
top  of  the  water  will  decompose  more  rapidly  than  when  at 


50  MEDICAL    JURISPRUDENCE. 

the  bottom  ;  and  when  taken  out  of  the  water  and  exposed 
to  the  air,  the  putrefaction  will  be  far  more  rapid  than  if 
left  in  the  water. 

External  Signs  of  Putrefaction. — The  following  is  the  order 
generally  observed,  externally,  in  the  progress  of  putre- 
faction of  bodies  exposed  to  the  open  air.  In  from  one  to 
three  days  in  summer  (three  to  six  in  winter),  there  appears 
a  greenish  or  yellowish-green  spot  upon  the  abdomen,  three 
or  four  inches  in  diameter,  accompanied  with  the  peculiar 
odor  of  putrefaction.  The  eyeball  becomes  soft  and  yield- 
ing within  the  same  period.  In  a  few  days  more  this 
greenish  discoloration  has  spread  generally  over  the  whole 
body — first  in  spots,  which  subsequently  gradually  coalesce. 
Dirty  red  streaks  now  show  themselves  throughout  the 
surface,  marking  the  course  of  the  blood-vessels.  In  ten  or 
fifteen  days  (in  warm  weather)  the  epidermis  begins  to 
loosen,  forming  blebs  or  blisters  containing  fluid.  Gases 
now  begin  to  form  in  the  chest  and  abdomen,  causing  these 
cavities  to  swell  out  greatly.  The  eyeballs  protrude  from 
the  same  cause ;  the  face  is  swollen  ;  the  features  are  so 
much  bloated  as  to  be  no  longer  recognizable.  In  two  or 
three  weeks  the  blebs  of  the  cuticle  may  have  burst  open  ; 
maggots  appear ;  the  formation  of  gases  increases,  so  that 
the  body  is  enormously  swollen.  If  it  be  now  punctured, 
the  gas  which  is  emitted  will  frequently  take  fire  on  the 
approach  of  a  flame  (hydrocarbons).  Other  gases  are  like- 
wise formed,  the  result  of  animal  decomposition,  as  car- 
bonic acid,  hydrogen  sulphid,  hydrogen  phosphid,  nitrogen, 
and  amin.  The  nails  now  loosen  ;  and  in  the  further  prog- 
ress of  putrefaction  the  cavities  burst  open  and  discharge 
their  contents  ;  the  softened  flesh  dissolves  off  from  the 
bones,   which   now    become    exposed,   and   ultimately   fall 


7    \jJa\I^IAM 


iU-^  eUa^  u  owr»^  ^n*-*^ 


ORDER    OF    PUTREFACTION.  5  I 


apart  from  the  skeleton.  The  sexes  cease  to  be  distin- 
guishable, except  perhaps  by  the  discoveiy  of  a  uterus, 
which  appears  to  be  almost  the  last  organ  to  yield  to 
putrefaction. 

The  foregoing  description  is  only  a  general  and  average 
one,  since  the  process  of  the  external  putrefaction  of  the 
body  is  variable,  and  is  influenced  by  many  circumstances, 
some  of  which  are  not  yet  fully  understood. 

Internal  Signs  of  Putrefaction. — The  order  in  which  the 
internal  organs  of  the  body  undergo  decomposition  being 
more  regular  as  to  time,  affords  a  rather  better  criterion  as 
to  the  period  of  death.  The  first  organ  of  the  body  that 
shows  signs  of  decomposition  after  death  is  the  lining  mem- 
brane of  the  windpipe  (larynx  and  trachea) ;  this  assumes 
a  dirty  red  coloration  simultaneously  with  the  appearance 
of  the  greenish  spot  upon  the  abdomen.  That  this  is  not 
the  result  of  injection  of  the  blood-vessels  is  proved  by  the 
microscope.  In  the  earliest  stage  of  death  this  membrane 
is  always  very  pale,  except  when  the  death  has  been  caused 
by  laryngitis  or  suffocation.  The  examiner  should  be 
cautioned  not  to  mistake  this  mark  of  putrefaction  for  con- 
gestion. Veiy  soon  after  this  stage  of  redness  it  becomes 
of  an  olive-green  color,  the  rings  of  the  trachea  separate, 
and  it  falls  to  pieces  and  disappears. 

The  next  (2)  organ  to  decompose  is  the  brain  of  young 
infants.  The  reason  of  this  lies,  of  course,  in  the  fact  that 
this  organ  at  such  an  early  age  is  so  very  delicate  and  is 
so  little  protected  by  its  bony  covering  from  the  outer  air. 
When  decomposing,  it  changes  into  a  soft,  rosy,  pulpaceous 
mass,  and  flows  out  of  the  smallest  openings. 

Then  follows  (3)  the  stomach.  This  organ  is  among  the 
earliest  to   putrefy  after   death.     The   decomposition    first 


52  MEDICAL   JURISPRUDENCE. 

manifests  itself  in  discolorations  of  the  fundus,  together  with 
the  formation  of  dirty  red  spots  or  streaks  in  the  posterior 
portion  of  the  organ,  owing  to  hypostatic  congestion. 
These  spots  soon  ramify,  and  cover  the  whole  lining  mem- 
brane. There  is  great  risk  of  mistaking  these  spots  for 
signs  of  congestion  or  inflammation  due  to  irritant  poison- 
ing. The  examiner  should  be  specially  cautious  on  this 
point,  as  it  is  often  impossible  to  distinguish  them  apart  by 
a  merely  ocular  inspection.  It  is  quite  certain  that  a  post- 
mortem redness  of  the  mucous  membrane  of  the  stomach 
cannot,  of  itself,  prove  a  case  of  poisoning.  In  the  further 
progress  of  putrefaction  the  stomach  softens,  the  spots  be- 
come greenish  and  gray,  then  black,  with  dark  red  streaks 
(veins)  running  through  them.  It  is  finally  converted  into 
a  pulpaceous  mass,  and  ceases  to  be  recognized. 

Next  to  the  stomach  the  intestines  (4)  follow  in  the  pro- 
cess of  decomposition.  They  become  discolored,  very 
much  as  in  the  case  of  the  stomach ;  then  they  become 
distended  with  gas,  burst,  and  discharge  their  contents. 

The  spleen  (5)  comes  next  in  the  order  of  putrefaction. 
If  not  diseased  at  the  time  of  death,  it  may  retain  its  integ- 
rity for  two  or  three  weeks.  It  first  assumes  a  dark  red 
color  then  a  greenish-blue,  then  becomes  soft  and  pulpy,  so 
that  its  substance  can  be  rubbed  down  with  the  handle  of 
the  scalpel. 

Following  the  spleen,  the  omentum  and  mesentery  (6)  are 
the  organs  next  to  decay.  If  there  is  not  much  fat  con- 
nected with  them,  they  will  rapidly  dry  up  and  disappear. 

The  liver  (7)  resists  putrefaction  for  a  considerable  time 
after  death — in  adults  for  several  weeks.  In  infants  it  de- 
composes earlier.  It  first  becomes  of  a  green  color,  then 
black ;    then  softens,  shrivels,  and  finally   disappears.      In 


ORDER    OF    PUTREFACTION.  53 

case  of  death  by  arsenical  poisoning  the  Hver  might  resist 
decomposition  for  a  considerable  time. 

The  brain  of  adults  (8)  does  not  begin  to  show  signs  of 
putrefaction  until  the  end  of  the  fourth  or  fifth  week,  and 
sometimes  even  later.  The  process  is  usually  most  marked 
at  the  base,  which  softens  and  becomes  bluish-green,  and 
gradually  progresses  upward  and  then  inward.  If  the 
brain  has  been  injured,  as  by  a  depressed  bone,  or  by  a 
gunshot  wound,  it  is  affected  earlier. 

Next  in  order  is  the  heart  (9).  This  is  one  of  the 
toughest  of  all  the  organs.  The  softening  here  begins 
in  the  columnse  carneae,  and  progresses  toward  the  walls 
of  the  organ,  which  finally  deliquesce  into  an  unrecogniz- 
able mass. 

It  is  remarkable  that  the  lungs  (10),  which  are  very  soft 
organs,  and  are  so  nearly  connected  with  the  outward  air, 
should  resist  putrefaction  so  long.  These  organs  are  often 
found  quite  sound  for  weeks,  provided  they  were  healthy 
and  uninjured  at  death.  The  first  evidence  of  their  decom- 
position is  the  formation  of  little  bladders  of  air  in  the 
sulci,  between  the  lobes,  on  the  under  surface,  looking 
like  a  string  of  beads.  These  increase  rapidly,  the  lung 
structure  turning  first  green,  then  black,  and  finally  soften- 
ing and  disappearing. 

The  kidneys  (11)  follow  the  lungs.  They  become  red- 
dish-brown and  soften,  then  assume  a  greenish-black  color, 
and  disappear.  Next  in  order  (12)  follow  the  bladder 
and  esophagus;  next  (13)  the  pancreas,  which,  though  a 
soft  organ  and  located  near  the  stomach,  is  among  the 
last  to  decompose.  Then  follow  (14)  the  diaphragm  and 
the  arteries, — the  tissue  of  the  latter  persisting  when  ever>'- 
thing  around  it  has  fallen  into  a  shapeless  mass. 


54  MEDICAL    JURISPRUDENCE. 

Last  of  all,  according  to  Casper,  is  the  uterus  (15),  which 
has  been  found  to  retain  its  identity  at  the  end  of  seven 
months  after  death.  This  fact  is  of  great  medico-legal 
importance  where  the  question  arises  of  the  possibility  of 
pregnancy. 

This  description  of  the  progress  of  putrefaction,  both  ex- 
ternal and  internal,  of  the  hurtian  body  is  taken  chiefly  from 
Casper.  It  is  intended  to  represent  the  average,  both  as 
regards  appearance  and  time.  As  already  stated,  there 
may  be  considerable  deviations  from  the  order  laid  down, 
depending  upon  circumstances.  Modern  embalming  has 
reached  such  a  stage  of  perfection  as  to  delay  putrefaction 
indefinitely.  Embalmed  bodies  have  been  exhumed  after 
two  years'  burial  and  evidences  of  injury  proven  to  the  en- 
tire satisfaction  of  an  accident  insurance  company,  at  whose 
instance  the  examination  was  made. 


Saponification  or  Adipocere. — It  sometimes  happens  that 
the  process  of  putrefaction  is  interfered  with  under  peculiar 
circumstances  and  gives  place  to  a  condition  known  as  the 
saponification  of  the  body.  This  was  first  observed  by 
Fourcroy,  who  discovered,  during  the  removal  of  human 
remains  from  one  of  the  public  cemeteries  of  Paris,  that  a 
number  of  the  bodies,  instead  of  undergoing  ordinary  putre- 
faction, had  been  converted  into  a  new  substance,  which  he 
styled  adipocere. 

This  adipocere  has  an  unctuous  feel,  somewhat  like  sper- 
maceti and  is  of  a  dirty  white  color.  Chevreul  found  it  to 
be  an  ammonium  soap — principally  ammonium  oleate  and 
stearate.  The  ammonium  is  derived  from  the  nitrogen  of 
the  tissues.     The  presence  of  water  seems  to  be  essential 


ADIPOCERE.  55 

to  this  change.  It  only  occurs  in  bodies  that  have  been 
buried  in  wet  or  very  moist  soil  and  never  in  those  in  a 
loose  or  sandy  soil.  Frequently,  when  a  grave  fills  with 
water,  the  contained  body  is  converted  into  adipocere.  The 
same  thing  may  take  place  in  bodies  which  remain  in  the 
water  for  a  certain  time. 

The  composition  of  adipocere  is  not  always  precisely  the 
same.  It  is  usually  an  ammonium  soap,  but  may  contain 
calcium  —  the  latter  condition  existing  especially  when  the 
body  has  been  immersed  in  water  containing  notable 
amounts  of  calcium  salts.  This  was  determined  experi- 
mentally by  Orfila,  who  placed  an  ammonium  adipocere  in 
a  solution  of  calcium  sulphate  ;  he  found  that  after  a  time 
it  had  been  changed  into  calcium  oleo-stearate.  Adipocere 
is  insoluble  in  water,  but  partially  soluble  in  alcohol.  It 
emits  a  greasy  smell  in  burning.  Its  odor  resembles  some- 
what that  of  musty  cheese. 

From  the  fact  that  if  a  body  remain  immersed  in  the 
water  for  any  length  of  time  it  is  likely  to  be  changed  into 
adipocere,  it  becomes  an  important  medico-legal  question 
to  establish  the  period  necessaiy  for  this  conversion.  De- 
vergie  ascertained  that  the  body  of  a  new-born  child  was 
more  or  less  changed  into  adipocere  after  remaining  in  the 
water  for  five  or  six  weeks.  We  see  at  once  the  value  of 
this  knowledge,  since  bodies  of  new-born  infants  are  fre- 
quently thrown  into  wells,  privies  and  cesspools.  If  a 
body  be  found  under  such  circumstances,  with  the  process 
of  saponification  only  just  begun,  it  is  probable  that  it  could 
not  have  been  long  in  the  water  and  vice  versa.  Accord- 
ing to  the  same  authority  an  adult  body  requires  an 
immersion  in  water  for  one  year  before  the  conversion  is 
completed,  and  when  it  is  buried  in  wet  earth,  a  period  of 


56  MEDICAL   JURISPRUDENCE. 

three  years  may  elapse  before  the  change  is  completely 
effected. 

Mummification. — This  constitutes  another  process  by 
which  the  ordinary  putrefaction  of  the  body  is  interfered 
with.  By  mummification  we  understand  the  complete 
'  desiccation  or  drying  up  of  the  body.  It  results  either 
from  burial  in  the  arid  and  sandy  soil  of  hot  countries, 
.  such  as  Arabia  and  Egypt,  or  from  exposure  of  the  body 
/  to  a  constantly  cold  and  dry  atmosphere  —  where,  for  in- 
i  stance,  it  is  placed  in  a  vault  through  which  a  constant 
stream  of  dry,  cold  air  is  pouring.  Such  a  condition  of 
things  is  found  at  the  Hospice  of  St.  Bernard,  in  Switzer- 
land. In  the  charnel  house  attached  to  this  establishment 
the  bodies  of  those  who  have  perished  in  the  snows  are 
placed.  The  atmosphere  is  so  constantly  cold  and  dry 
that  the  flesh  and  fat  completely  dry  up. 

It  is  quite  impossible,  from  the  mere  inspection  of  a 
mummy,  to  venture  an  opinion  as  to  the  length  of  time 
that  has  elapsed  since  death.  Many  Egyptian  mummies 
are  several  thousand  years  old. 

Certain  agents  retard,  and  others  promote,  decomposition. 
The  former  comprise  the  various  antiseptics.  Lime,  although 
popularly  supposed  to  hasten  putrefaction,  in  reality  retards 
it,  as  is  shown  by  a  simple  experiment  of  Dr.  John  Davy, 
who  buried  a  piece  of  raw  flesh  that  had  been  first  covered 
over  with  powdered  lime.  It  continued  sound  much  longer 
than  another  piece  that  was  buried  without  the  lime.  No 
doubt  the  lime  here  partly  operated  by  excluding  the  atmos- 
pheric air.  The  strong  acids  and  alkalies,  although  they  do 
not  hasten  putrefaction,  produce  chemic  changes,  and  in  this 
way  aid  in  the  removal  of  a  body. 


MUMMIFICATION.  5/ 

The  period  and  method  of  interment  materially  influence 
the  rapidity  of  putrefaction.  If  decomposition  has  set  in 
before  burial,  the  action  will  progress  far  more  rapidly  than 
in  a  body  which  was  interred  before  putrefaction  had  begun. 
The  depth  of  the  grave  and  nature  of  the  soil  also  exercise  a 
marked  influence.  The  cause  of  death  may  influence  the 
rapidity  of  the  decomposition  of  the  body. 

Having  disposed  of  the  first  question  —  is  the  death  real 
or  apparent  ?  —  we  may  consider  the  second  :  How  long  a 
time  has  elapsed  smce  the  death  ?  It  sometimes  becomes 
of  extreme  consequence  to  determine  this  in  connection 
with  the  attempt  to  prove  an  alibi  on  the  part  of  the  pris- 
oner. This  matter  is  to  be  determined,  in  the  absence  of 
direct  evidence,  solely  by  attending  to  the  different  "  signs  " 
or  phenomena  of  death,  already  described.  The  inferences 
may  be  drawn,  first,  from  the  signs  occurring  before  putre- 
faction ;   secondly,  from  those  occurring  after  it. 

I .  Inferences  From  the  Sig?is  Exhibited  Before  Putrefaction. 
—  If  the  body  is  only  slightly  cold,  and  rigidity  is  just 
commencing  about  the  jaws,  the  eyes  glazed,  and  the  eye- 
balls sunken,  death  has  occurred,  most  probably,  from  a 
quarter  of  an  hour  to  four  or  five  hours  previously.  The 
inference  can  never  be  more  than  approximative  for  the 
reasons  already  given. 

Suppose  the  body  to  be  perfectly  cold  (externally)  and 
rigid  throughout ;  it  has  probably  been  dead  from  twelve  or 
fifteen  hours,  to  three  or  four  days.  If  rigidity  is  complete 
over  the  body,  and  cadaveric  lividity  (suggillation)  js  mani- 
fested over  the  surface,  death  has  probably  occurred  one  to 
four  days  previously. 

The  importance  of  attending  to  the  above  phenomena  is 

5 


58  MEDICAL   JURISPRUDENCE. 

shown  by  a  case  mentioned  by  Taylor.  A  man  was  con- 
victed and  transported  for  killing  his  wife.  The  woman  was 
discovered,  at  8  o'clock  in  the  morning,  with  her  throat 
cut.  She  was  very  rigid  throughout  the  upper  part  of  her 
body,  and  the  whole  body  was  cold.  The  prisoner  was  able 
to  prove  an  alibi  between  the  hours  of  4  and  8  a.  m.,  and 
his  counsel  endeavored  to  show  that  the  post-mortem  cold- 
ness and  the  partial  rigidity  might  have  developed  within 
four  hours,  which,  if  true,  would  have  exculpated  the 
accused.  This  point  was  overruled  by  a  mass  of  medical 
testimony  to  the  contrary. 

2.  Inferences  aftei' Putrefaction. — Suppose  the  body  ex- 
hibits the  gi'eenish  discoloration  on  the  abdomen  and  the 
pecuHar  odor  of  putrefaction  exists  ;  the  rigor  mortis  has 
passed  off,  leaving  the  body  cold,  but  pliant :  death  has 
probably  occurred  one  to  three  days  previously,  in  summer, 
and  three  to  six  or  eight  days,  in  winter. 

If  the  greenish-yellow  discoloration  extends  more  or  less 
over  the  whole  surface,  together  with  greenish-brown  stains, 
and  dark  red  lines  over  various  parts,  along  with  relaxation 
of  the  sphincter  ani  muscle,  it  must  have  been  dead  from 
eight  to  ten  days,  in  summer,  and  from  ten  to  twenty  days, 
in  winter. 

If  blebs  are  found  over  the  skin,  and  some  of  them 
opened,  with  maggots  in  the  muscles ;  if  the  body  is  green 
all  over,  and  the  chest  and  abdomen  are  enormously  dis- 
tended ;  the  nails  loose,  or  falling  out ;  the  color  of  the  eyes 
not  recognizable  ;  the  features  very  much  swollen — then  the 
death  must  have  occurred  two  to  three  weeks  previously, 
in  summer,  or  four  to  five  weeks,  in  winter. 

If  the  chest  and  abdomen  have  burst  open  and  dis- 
charged their  contents,  and  some  of  the  bones  are  denuded 


INFERENCES    AFTER    PUTREFACTION.  59 

of  their  fleshy  coverings  ;   the  eyes   enormously  swollen  ; 
the  body  has  been  dead,  probably,  from  two  to  four  months. 

The  above  "  inferences,"  it  must  be  remembered,  are  only 
approximative.  They  cannot  be  positive  under  any  circum- 
stances ;  and,  moreover,  they  are  predicated  on  the  suppo- 
sition that  the  body  under  examination  has  not  been  buried, 
but  exposed  to  the  action  of  the  atmosphere.  Great  care 
must  be  taken  not  to  give  a  very  positive  opinion  on  this 
question,  as  the  inferences  are  to  a  great  extent  conjectural, 
and  dependent  on  many  contingencies. 

Some  definition  of  winter  and  summer  should  be  given — 
e.  g.,  over  60°  for  summer,  and  below  this  for  winter. 

Attempts  have  been  made  recently  by  some  French 
observers  to  determine  what  time  has  elapsed  since  the 
interment  of  a  body,  by  the  succession  of  various  species  of 
animal  life  developing  in  and  about  the  tissues,  and  some 
interesting  results  have  been  obtained.  Such  data,  how- 
ever, will  need  to  be  verified  for  each  district,  season,  and 
kind  of  soil  before  being  of  any  practical  value. 


CHAPTER  III. 

MEDICO-LEGAL  INVESTIGATIONS— THE  POST-MORTEM. 

The  physician  who  undertakes  the  examination  in  a 
medico-legal  case,  including  a  post-mortem,  assumes  a  seri- 
ous responsibility.  He  must  be  fully  prepared  to  meet  the 
various  contingencies  that  may  present  themselves,  and  he 
should  execute  his  work  thoroughly  and  with  strict  impar- 
tiality. The  examiner  should  be  an  expert  anatomist  and 
pathologist,  and  a  close  and  careful  observer. 

In  all  cases  where  dispute  is  likely  to  arise,  it  is  advis- 
able to  have  two  examiners,  and  any  suspected  person 
should  be  allowed  representation  by  some  one  of  his  own 
selection.  It  will  be  proper,  however,  to  secure  the  con- 
sent of  the  coroner,  public  prosecutor,  or  other  officer  for 
representatives  of  suspected  or  interested  parties  to  be 
present.  As  a  general  rule  such  opportunities  are  not 
solicited  by  attorneys  representing  clients  accused  of  crime. 
The  examination  should  be  made  by  daylight,  since  artifi- 
cial light  conceals  shades  of  color  which  it  is  important  to 
recognize,  such  as  stains  by  nitric  acid.  Analytic  and 
microscopic  investigations  are  needed  in  many  cases,  and 
great  care  should  be  taken  to  place  all  organs  which  are 
to  be  examined  for  poison  in  separate  clean  jars.  Many 
physicians  will  thoughtlessly  place  several  abdominal  viscera, 
such  as  liver,  kidney,  and  stomach,  in  one  jar ;  but  this  is 
highly  objectionable,  since  it  deprives  the  chemist  of  all 
opportunity  to  determine  if  the  poison  has  been  absorbed 
during  life,  a  most  important  point.     If  examinations  are  to 

60 


THE   POST-MORTEM;  6 1 

be  made  for  blood  stains,  on  the  clothing  ot  the  body  or  on 
any  surrounding  objects,  these  should  be  marked,  wrapped 
up  and  preferably  removed  from  the  room  or  immediate 
vicinity  of  the  body  before  the  post-mortem  is  begun,  there- 
by avoiding  the  suspicion  that  the  objects  had  become 
blood-stained  during  the  post-mortem,  which  would  de- 
stroy the  value  of  any  evidence  adduced  by  future  exami- 
nation. 

The  examination  should  be  exhaustive,  so  that  the  exam- 
iner may  be  able  to  testify  with  some  positiveness  as  to  the 
cause  of  death.  For  example,  the  discovery  of  a  disease  of 
the  heart  sufficient  to  cause  death  should  not  preclude  an 
examination  of  the  lungs  and  brain,  in  either  of  which  the 
real  cause  of  the  death  may  be  found.  Poison  in  the 
stomach  may  coexist  with  a  ruptured  aneurysm,  a  clot  in 
the  brain,  or  a  diseased  heart.  The  examination,  more- 
over, should  be  conducted  methodically,  and  all  the  details 
recorded. 

The  post-mortem  ought  to  be  made  on  the  first  day  sub- 
sequent to  the  death,  but  it  should  never  be  declined  on 
account  of  the  interval  that  may  have  elapsed,  nor  even  if 
the  body  be  in  a  state  of  putrefaction. 

The  surroundings  should  first  claim  attention,  such  as  the 
locality  at  which  the  body  was  discovered,  as  this  may  afford  a 
clue,  especially  in  the  case  of  infanticide^  when  for  example, 
the  body  of  the  infant  is  found  in  a  privy-well  or  dung-heap. 
Sometimes  the  body  will  have  been  dragged  by  the  murderer 
to  a  distant  spot ;  or  the  victim  may  have  followed  his  assail- 
ant a  short  distance  after  receiving  the  blow.  Footmarks 
should  be  noted,  together  with  their  direction  ;  evidences  of 
strnggling,  as  denoted  by  the  condition  of  the  grass,  dust, 
or  mud  in  the  road,  and  disturbed  or  broken  condition  of 


62  MEDICAL   JURISPRUDENCE. 

bushes,  which  also  may  be  bespattered  with  blood ;  the 
finding  of  a  weapon  or  missile.  Marks  of  bloody  fingers  or 
blood  tracks  from  bloody  shoes  should  be  sought  for  before 
any  blood  is  drawn  by  the  post-mortem  examination.  If 
there  be  no  wound  or  evidence  of  bleeding  having  occurred 
from  the  body  under  examination,  the  presence  of  blood  on 
the  hands  or  any  part  of  the  clothing  or  body  would  sug- 
gest that  his  assailant  had  received  a  wound.  If  in  a  room, 
the  position  of  the  body  in  reference  to  articles  of  furniture, 
to  any  weapon,  to  glasses,  cups,  bottles,  etc.,  from  which 
poison  may  have  been  taken.  It  is  also  advisable  to  make 
a  rough  drawing  of  the  locality. 

As  regards  the  body  itself,  the  examiner  should  note  its 
exact  position  when  found  :  this  is  especially  important  if 
death  was  caused  by  a  wound.  The  clothes  should  be 
carefully  examined  to  determine  whether  torn  or  cut,  and 
whether  any  torn  fragment  corresponds  with  the  garment 
of  the  accused,  or  of  the  deceased  ;  whether  marked  by 
blood-stains,  or  by  an  acid ;  if  stabbed,  whether  the  cuts 
correspond  with  the  wounds  on  the  body.  The  clothes 
should  be  removed,  and  the  body  minutely  inspected.  It 
should  also  be  identified,  if  possible.  Notes  should  also  be 
made  of  the  sex,  height,  weight,  age,  and  general  develop- 
ment ;  of  scars  and  other  marks  ;  abnormalities ;  blood, 
seminal,  and  other  stains ;  the  color  of  the  skin  and  condi- 
tion of  the  eyes  and  teeth  ;  the  temperature  and  rigidity  of 
the  body  ;  the  degree  of  putrefaction  ;  lividity  and  ecchy- 
moses  ;  matters  flowing  from  the  nose,  mouth,  and  ears  — 
blood  from  or  in  either  of  these  orifices  is  often  indicative  of 
fracture  of  the  skull ;  state  of  the  tongue ;  expression  of  the 
countenance.  The  hands  should  be  inspected,  to  ascertain 
if  they  hold  a  weapon — whether  loosely  or  tightly  grasped ; 


THE    POST-MORTEM.  63 

or  if  portions  of  hair  or  clothing  are  firmly  held  (denoting 
a  struggle),  and  whether  these  articles  correspond  with 
those  found  on  the  prisoner  ;  whether  stained  with  blood 
or  blackened  by  powder  (the  latter  indicating  firearms). 
The  presence  or  absence  of  foreign  bodies  in  the  nose, 
mouth,  anus,  and  vagina  should  also  be  noticed. 

All  wounds  should  be  carefully  examined  as  to  depth, 
extent,  and  direction,  and  whether  they  suit  the  weapon 
that  may  be  supposed  to  have  occasioned  them  ;  the  condi- 
tion of  their  edges,  as  indicating  whether  recent  or  not ; 
marks  of  inflammation,  suppuration,  or  gangrene  ;  whether 
any  foreign  body  be  present,  as  a  ball,  fragments  of  cloth- 
ing, etc.  The  scalpel  may  be  used,  if  necessary,  to  enlarge 
the  wound,  with  care  not  to  interfere  with  its  original  char- 
acter. If  there  is  contusion  without  solution  of  continuity, 
the  examiner  should  not  fail  to  look  for  internal  injuries. 

In  fractiu'cs  and  luxations,  notice  their  condition  and  that 
of  the  surrounding  parts.  In  cases  of  burns,  observe  their 
degree  and  extent ;  whether  merely  inflamed  or  vesicated, 
and  the  state  of  the  adjacent  parts. 

\\\  females,  examine  the  genital  organs,  especially  in  case 
of  alleged  rape,  pregnancy,  and  recent  delivery. 

In  nezv-born  cJiildreii,  ascertain  their  length  and  weight, 
their  color,  sex,  diameters  of  head,  the  condition  of  the 
lungs,  hair,  nails,  membrana  pupillaris,  genital  organs,  and 
condition  of  the  umbilical  cord.  The  question  of  a  live -birth 
will  be  treated  more  fully  in  a  later  part  of  this  work. 

The  modern  methods  of  photography  permit  valuable 
pictures  to  be  taken,  so  as  to  preserve  accurate  evidence  of 
the  surroundings  and  position  of  a  body.  It  is  scarcely  nec- 
essary to  refer  to  the  uses  that  X-ray  methods  may  subserve 
in  medico-legal  work. 


64  MEDICAL  JURISPRUDENCE. 

The  Internal  Examination  of  the  Body. — It  is  impor- 
tant that  the  examination  should  be  thorough  and  syste- 
matic, and  in  order  to  secure  this  it  will  be  necessary  to 
follow  a  definite  course  under  all  circumstances,  or  to  be 
able  to  supply  a  sufficient  reason  for  a  deviation  in  any  par- 
ticular case.  If  the  investigator  be  in  the  habit  of  always 
examining  the  head  last,  he  will  be  astonished  at  the  amount 
of  blood  which  will  escape  if  the  head  be  examined  first, 
and  thus,  by  varying  his  usual  course,  may  mislead  him- 
self, attributing  the  increased  flow  to  abnormal  conditions 
when  they  are  not  present.  The  following  order  is  com- 
mended as  offering  the  best  advantages  with  the  fewest 
variations.  It  is  assumed  that  the  external  examination 
has  been  completed. 

Tlic  Abdomen. — An  incision  is  made  from  the  interclav- 
icular notch  to  the  pubes,  passing  to  the  left  of  the  navel  in 
order  to  preserve  the  ligament,  and,  in  the  new-born,  the 
vessels  which  pass  to  the  liver.  The  incision  is  carried 
entirely  through  the  abdominal  wall,  care  being  taken  not 
to  wound  the  viscera ;  the  integument  is  then  dissected 
from  the  chest  wall  as  far  back  as  the  costal  cartilages  of 
both  sides  ;  by  forcibly  stretching  both  sides  of  this  incision, 
an  abundance  of  room  will  be  supplied  without  any  trans- 
verse incisions,  except  in  rare  cases  ;  in  stripping  the  chest 
wall  care  must  be  used  to  avoid  the  smallest  opening  of 
the  thoracic  cavity,  as  any  contained  fluids  —  blood,  for 
example  —  may  escape,  or  entering  air  may  change  the 
position  of  the  diaphragm,  which  it  may  be  important  to 
obsei-ve.  The  abdominal  cavity  is  now  to  be  examined, 
noting  the  organs  in  detail.  Note  the  fluid  present  ;  is  it 
clear  or  cloudy  ;  amount ;  search  for  evidence  of  peritonitis, 
extravasation   of  blood    or  the   contents   of  the   stomach, 


THE    INTERNAL    EXAMINATION    OF    THE    BODY.  65 

intestine,  gall-bladder,  or  urinary  bladder,  the  finding  of 
which  will  indicate  that  there  has  been  a  wound  or  rupture 
of  some  of  the  viscera.  If  such  be  found  it  must  be  closed, 
and  the  cavity  carefully  cleansed  and  dried  before  the  chest 
is  opened,  as  the  foreign  material  in  the  belly  cavity  would 
immediately  flow  into  the  chest  and  complicate  the  examina- 
tion of  the  thoracic  viscera.  The  height  of  the  diaphragm 
is  to  be  noted  (especially  in  new-born  children,  where  ques- 
tion of  still-birth  is  likely  to  arise)  before  the  chest  is  opened, 
as  immediately  after  no  inference  can  be  drawn,  as  the  posi- 
tion of  the  diaphragm  after  the  chest  has  been  opened  may 
change.  In  cases  of  suspected  poisoning  the  stomach  should 
be  ligated  at  both  ends  before  opening  the  chest,  as  the 
gullet  might  be  accidentally  wounded,  and  the  stomach 
contents  thereby  permitted  to  escape.  The  abdominal  vis- 
cera are  not  to  be  examined  until  after  the  chest,  as  the 
removal  of  any  organ  will  drain  the  blood  from  the  heart, 
and  thereby  prevent  an  accurate  examination  of  that  organ. 

TJie  Thorax. — The  costal  cartilages,  together  with  the 
sterno-clavicular  ligaments,  should  be  carefully  divided, 
avoiding  the  large  veins  of  the  neck,  the  pericardium  and 
its  contents  ;  the  sternum  is  now  reflected. 

Do  the  lungs  immediately  collapse,  or  do  they  fill  the 
chest  cavity  to  distention  ?  Examine  pleurae  for  adhesions  ; 
note  character  and  quantity  of  fluid  in  each  pleura  sepa- 
rately ;  remove  all  fluid  from  the  pleurae  in  order  to  prevent 
the  pericardium  from  being  flooded  when  opened.  Open 
the  pericardium  in  the  axis  of  the  heart,  being  careful  not 
to  wound  the  heart ;  this  can  be  best  secured  by  pinching 
up  the  sac  and  transfixing,  with  the  back  of  the  knife 
toward  the  heart,  and,  as  soon  as  an  opening  is  secured, 
introducing  two  fingers  into  the  cavity,  and  thereby  protect- 


66  MEDICAL   JURISPRUDENCE. 

ing  the  heart.  Note  the  character  and  quantity  of  the 
pericardial  fluid ;  note  the  condition  of  the  heart  as  to 
distention  of  cavities  ;  see  that  the  great  vessels  given  oft 
from  the  heart  are  in  the  normal  relation  to  that  organ  ; 
open  the  heart  in  situ ;  note  in  detail  the  contents  of  the 
cavities  ;  is  the  blood  fluid  or  in  clots  ?  are  the  clots  white, 
black,  or  red  ?  This  is  important,  as  it  may  establish 
whether  the  death  was  sudden  or  prolonged.  If  the  right 
side  of  the  heart  contain  distinct  ante-mortem  clots,  it  is 
highly  improbable  that  the  death  could  have  been  sudden,  as 
by  drowning.  A  man  was  found  in  the  water  three  months 
after  his  disappearance,  and  it  was  presumed  that  he  was 
murdered  and  thrown  into  the  stream.  At  the  post-mortem 
evidence  was  found  of  ante-mortem  injury,  and  clots  were 
found  in  the  cavities  of  the  heart ;  but  no  note  was  made 
of  their  character,  and  the  plea  of  accidental  drowning,  set 
up  by  the  defense,  could  not  be  refuted.  Had  the  medical 
examiner  been  able  to  testify  that  the  clots  were  undoubt- 
edly ante-mortem,  it  would  have  established  that  the 
death  was  considerably  slower  than  could  have  been  the 
case  in  drowning.  Distinctly  ante-mortem  clots  are  posi- 
tive indications  of  the  death  agony  not  having  been  instan- 
taneous, and  may,  for  this  reason,  be  of  the  greatest  im- 
portance in  establishing  the  exact  time  at  which  the  injury 
was  received  or  the  poison  given.  The  heart  may  next  be 
removed  by  cutting  through  the  vessels  at  its  base,  and 
examined  as  to  its  weight,  condition  of  its  walls  and  tissue, 
and  state  of  its  valves.  Sometimes  a  microscopic  investi- 
gation may  be  required.  The  aorta  should  likewise  be 
examined  for  atheroma  and  aneurysm. 

The  lungs  may  be  removed  by  passing  the  hand  beneath 
them   (noticing   any   adhesions),    and   cutting   through  the 


THE  INTERNAL  EXAMINATION  OF  THE  BODY.      6/ 

bronchi  and  vessels  at  their  roots.  They  should  be  in- 
spected as  to  their  color,  density,  etc.,  as  indicating  disease ; 
the  condition  of  the  bronchial  tubes  and  pulmonary  artery 
(embolism) ;  and  the  presence  of  foreign  matters  in  the  air 
passages  (in  case  of  drowning  or  of  sudden  death).  A  man 
in  apparent  health,  while  away  from  home,  became  sud- 
denly cyanosed  and  fell  unconscious  from  his  seat  at  the 
table  after  eating  heartily.  Relatives  claimed  that  he  was 
poisoned.  A  careful  examination  revealed  the  presence  of 
an  irregular  fragment  of  a  potato  in  each  bronchus,  com- 
pletely occluding  the  entrance  of  air  ;  and  it  was  afterwards 
shown  that  he  habitually  bolted  his  food.  A  cud  of  tobacco 
or  stump  of  a  cigar  might  as  easily  give  rise  to  the  same 
difficulty.  If  blood  has  escaped  into  the  thorax  it  should 
be  removed  by  a  sponge,  so  as  to  ascertain  the  color  of  the 
parts.  The  hydrostatic  examination  of  the  lungs  in  new- 
born children,  in  cases  of  infanticide,  will  be  considered  fur- 
ther on. 

The  ribs  should  be  examined  in  succession  for  evidence 
of  fracture  or  other  injury.  The  esophagus  may  be 
cut  from  its  attachments  in  the  neck,  stripped  from  the 
chest,  and  left  to  be  removed  with  the  stomach  ;  a  ligature, 
in  case  of  suspected  poisoning,  should  be  placed  at  the  car- 
diac end  of  the  stomach  to  prevent  regurgitation  of  the  gas- 
tric contents  ;  the  esophagus  may  be  opened  down  to  the 
ligature,  and  its  interior  examined  for  corrosion  or  other 
evidence  of  poison  or  injury.  The  organs  of  the  abdominal 
cavity  are  to  be  next  examined  —  the  spleen,  kidneys,  and 
bladder.  If  any  urine  be  present  in  the  bladder,  it  should 
be  carefully  preserved  in  a  chemically  clean  bottle,  that  it 
may  be  examined  for  albumin,  sugar,  or  for  poisons ;  in.  the 
latter  case  some  of  the  alkaloidal  poisons  (atropin,  strych- 


68  MEDICAL   JURISPRUDENCE. 

nin,  etc.)  can  be  physiologically  tested  for  by  injecting 
some  of  the  suspected  urine,  hypodermatically,  into  sus- 
ceptible animals,  or  chemically,  as  will  be  discussed  later. 
The  internal  and  external  genital  organs  are  to  be  examined 
next,  and,  in  the  female,  the  uterus  especially,  for  evi- 
dences of  pregnancy,  abortion,  or  delivery.  The  liver 
should  be  next  examined. 

The  Stomach  should  be  examined  by  first  ligating  it  at 
the  cardiac  extremity,  and  then  by  applying  two  ligatures 
at  the  pyloric  end,  and  cutting  between  the  latter.  Note 
the  general  external  appearance,  and  then  open  it  along  its 
lesser  curvature.  Examine  the  contents,  as  to  quantity, 
character  and  odor,  and  reaction.  Carefully  inspect  the 
Hning  membrane  with  a  lens  for  solid  particles  of  phos- 
phorus, crystals  or  patches  of  arsenic,  or  other  mineral 
poisons,  fragments  of  leaves  or  seeds,  or  other  foreign 
matters.  Note  any  evidences  of  inflammation  or  ulceration. 
If  an  analytic  examination  of  the  stomach  and  its  contents 
is  to  be  made,  it  is  better  if  it  can  be  so  arranged  not  to 
open  the  stomach  until  it  is  delivered  to  the  chemist. 
Under  ordinary  circumstances,  except  in  well-appointed 
morgues,  no  facilities  are  at  hand  for  examining  for  crys- 
tals, fragments  of  leaves,  etc.,  and  hence  this  had  better  be 
deferred  until  the  chemist  has  access  to  the  organ. 

The  Intestines,  after  inspection  for  twist,  strangulation,  or 
hernia,  should  next  be  examined,  by  removing  them  from 
their  attachments,  and  slitting  them  throughout  with  an 
enterotome  ;  looking  for  inflammation  and  ulceration  of  the 
glands,  and  for  any  foreign  matters  ;  also  noting  the  condi- 
tion of  the  appendix  vermiformis.  In  cases  of  poisoning, 
the  stomach  and  its  contents  should  be  preserved  for 
chemical  examination  in  a  separate  jar.     The  intestines  also 


THE    INTERNAL    EXAMINATION    OF    THE    BODY,  69 

(at  least  a  portion  of  the  small  and  large  bowel,  together 
with  the  rectum),  and  portions  of  the  liver,  one  kidney  and 
the  spleen  should  be  kept  for  a  similar  purpose.  The  jars 
containing  the  viscera  should  be  securely  stoppered  and 
sealed  with  the  private  seal  of  the  examiner,  with  a  label 
affixed,  stating  the  name  of  the  deceased  person,  the  date 
of  death  and  of  the  autopsy.  They  should  then  be  deliv- 
ered personally,  by  him,  to  a  responsible  party,  from  whom 
he  should  always  take  a  written  receipt.  The  preservation 
of  each  organ  in  a  separate  and  well-cleaned  —  preferably 
new — jar  is  to  be  especially  urged.  Toxicologic  examina- 
tions are  often  seriously  hampered  by  the  fact  that  stomach, 
liver,  and  kidneys  have  been  placed  in  one  large  jar.  Such 
a  condition  prevents  determining  the  ante-mortem  distribu- 
tion of  the  poison. 

The  Head. — After  a  careful  external  examination  for 
wounds  or  injuries,  for  which  purpose  the  hair  may  have  to 
be  removed,  the  scalp  should  be  separated  by  an  incision 
from  ear  to  ear  across  the  vertex,  down  to  the  bone  ;  it 
should  then  be  everted  in  both  directions  so  as  to  expose 
the  skull.  Search  for  fractures,  and  do  not  mistake  irregu- 
lar sutures  for  these.  Blood  along  the  line  of  a  suture  can 
be  wiped  off,  along  the  line  of  a  fracture  it  cannot ;  gentle 
tapping  on  the  bare  skull  may  give  a  "cracked  pot"  sound 
in  fracture.  Notice  any  unusual  thinness  of  bone  ;  follow 
out  any  fracture  to  its  whole  extent ;  observe  any  extrava- 
sation of  blood  under  the  scalp. 

The  skull  should  now  be  carefully  sawed  around,  about 
half  an  inch  above  the  opening  of  the  ear,  the  calvaria 
removed  (under  no  circumstances  should  the  hammer  or 
chisel  be  used),  and  the  condition  of  the  dura  mater  no- 
ticed.    Look  for  hemorrhage,  either   extradural    or   sub- 


70  MEDICAL    JURISPRUDENCE. 

dural ;  if  the  dura  has  come  off  with  the  calvaria,  it  should 
be  stripped  and  the  inner  table  of  the  skull  cap  closely  in- 
spected for  any  fracture  which  may  or  may  not  show  on  the 
outside.  This  membrane  should  be  carefully  cut  around 
with  a  probe-pointed  scissors  and  the  arachnoid  and  pia 
mater  closely  inspected. 

The  upper  part  of  the  brain  can  now  be  examined  before 
removal — as  to  congestion  of  its  vessels,  laceration,  or  ex- 
travasation of  blood  upon  its  surface.  This  latter  is  often 
seen  on  the  side  opposite  to  the  external  injury.  The  brain 
is  to  be  carefully  removed,  by  inserting  the  fingers  beneath 
it  and  dividing  the  medulla  oblongata.  The  base  of  the 
skull  should  be  carefully  inspected  for  fractures. 

The  brain  should  be  examined  from  above,  slicing  it  hori- 
zontally; regarding  specially  its  consistence,  color,  presence 
of  extravasated  blood  or  serum,  of  tumors  or  abscesses, 
disease  of  blood-vessels  or  of  the  membranes.  In  opening 
the  skull  of  very  young  children  a  pair  of  strong  scissors 
may  be  used  instead  of  a  saw. 

The  Spinal  Column  should  be  opened  through  its  whole 
extent,  by  sawing  through  on  each  side  of  the  spinous  proc- 
esses. The  cord,  together  with  the  dura  mater,  should  then 
be  removed  and  examined.  Note  any  fracture,  dislocation 
or  contusion. 

The  Neck  should  be  inspected  for  marks  of  violence  by 
the  fingers  (garroting);  by  a  cord  (strangling  or  hanging), 
and  for  ecchymoses.  Note  should  be  taken  as  to  the  con- 
dition of  the  great  vessels  and  nerves.  The  cavity  of  the 
mouth  and  nose  should  be  examined ;  also  the  condition  of 
the  larynx,  trachea,  pharynx,  and  esophagus. 

In  case  of  disinterment  of  a  body  the  inspectors  should 
always  view  it  before  it  is  removed  from  the  coffin  ;  at  which 


THE  INTERNAL  EXAMINATION  OF  THE  BODY.      "]  \ 

time,  also,  it  should  be  properly  identified  by  the  friends  or 
relatives  of  the  deceased. 

In  a  medico-legal  examination  of  a  body,  such  as  above 
described,  there  should  always  be  present  either  a  second 
inspector  or  a  clerk  to  take  down  the  notes  as  the  autopsy 
progresses.  These  notes  should  comprise  the  appearances 
presented  by  the  different  organs,  stating  facts,  not  opinions. 
The  notes  should  be  read  over  by  both  examiners  and,  if 
necessary,  corrected  before  sewing  up  the  body.  In  many 
cases  it  will  be  expected  that  a  report  should  be  drawn  up 
containing  opinions  of  the  case.  The  length  and  character 
of  this  report  will  depend  on  circumstances. 


CHAPTER    IV. 
PRESUMPTION  OF  DEATH,   AND  OF  SURVIVORSHIP. 

Presumption  of  Death. — This  question  may  be  raised 
when  a  given  person  is  not  heard  of  for  a  long  period. 
The  law,  in  that  event,  presumes  death,  and  the  adminis- 
trator or  executor  may  proceed  to  settle  the  estate.  This 
question  is  not  often  raised  in  life  insurance  cases,  when 
the  party  insured  has  not  been  heard  of  for  many  years, 
and  the  lawful  heirs  demand  the  payment  of  the  policy.  It 
must  also  be  considered  in  cases  in  which  either  married 
person  leaves  the  other  and  remains  continuously  away. 

The  length  of  time  usually  regarded  by  the  law  as  war- 
ranting a  presumption  of  death,  in  any  of  the  above  cases, 
is  seven  years  from  the  time  the  person  was  last  heard 
from  ;  so  that  in  the  case  of  married  persons  it  is  not 
regarded  as  bigamy  if  either  party  should  marry  again 
after  the  expiration  of  the  seven  years  of  continuous  absence 
without  communication  or  information  of  any  kind  on  the 
part  of  the  other.  In  cases  of  heirship  and  property,  and 
in  some  cases  of  life  insurance,  it  is  often  not  considered 
necessaiy  to  wait  the  whole  seven  years,  but  settlements 
have  been  made  by  the  courts  or  companies  in  two  years. 

The  presumption  of  death  must  depend  on  general  evi- 
dence, being  a  presumption  o{  fact  to  be  determined  by  a 
jury.  There  are  cases,  however,  of  a  special  character, 
where  the  courts  have  decided  the  presumption  of  death  to 
be  sooner  or  later  than  the  period  of  seven  years,  as,  e.  g.,  if 
the  individual   concerned   was  in  feeble   health  when   last 

72 


PRESUMPTION    OF    SURVIVORSHIP.  73 

heard  from.     This  question  would  involve  medical  evidence 
as  to  the  probabilities  of  life  in  such  a  case. 

Presumption  of  Survivorship. — Questions  relating  to 
presumption  of  survivorship  are  much  more  frequently  dis- 
cussed in  the  courts  than  those  pertaining  to  presumption 
of  death.  There  is,  however,  no  general  law  upon  the  sub- 
ject, either  in  this  country  or  Great  Britain,  every  case  in 
which  the  question  is  involved  being  decided  according  to 
its  individual  merits.  When  two  or  more  persons  perish  by 
the  same  calamity,  in  the  absence  of  all  testimony  the 
courts  frequently  refuse  to  assume  that  one  survived  the 
others,  but  have  decided  that  all  perished  together.  Yet 
momentous  questions  may  be  dependent  upon  a  legal  de- 
cision of  the  question  of  survivorship  ;  as  when  the  parties 
dying  are  a  father  and  a  son  ;  if  the  son  survive  but  for  a 
moment,  "  his  wife  shall  have  dower,  for  the  lands  descended 
the  instant  the  father  died."  So,  in  the  case  of  a  testator 
and  legatee  :  if  the  latter  die  first,  the  legacy  lapses  ;  but 
if  he  survives  the  testator  for  ever  so  short  a  time,  his 
executors  can  claim.  So,  again,  the  husband  of  a  woman 
possessed  of  freehold  property  (not  specially  settled)  has  a 
life  interest  in  her  estate,  provided  she  has  issue  by  him, 
born  during  the  life  of  the  mother,  and  which  survives  her 
even  for  a  moment  of  time  (tenancy  by  courtesy).  The  old 
Roman  law  upon  this  subject,  upon  which  are  based  most 
of  our  modern  decisions,  enacted  that  when  persons  of 
different  ages  perished  in  battle,  those  under  puberty  were 
deemed  to  have  died  first ;  but  if  the  son  was  above  the 
age  of  puberty,  and  both  died  together,  the  son  was  pre- 
sumed to  have  survived  the  parent.  In  the  case  of  husband 
and  wife,  the  husband  was  presumed  to  be  the  survivor 
(Beck). 


74  MEDLCAL   JURISPRUDENCE. 

According  to  Fodere  and  Beck,  the  French  law,  as  con- 
tained in  the  Code  Napoleon,  is  as  follows  : 

"I.  If  several  persons,  naturally  heirs  of  each  other,  per- 
ish by  the  same  event,  without  the  possibility  of  knowing 
which  died  first,  the  presumption  as  to  survivorship  shall  be 
determined  by  the  circumstances  of  the  case  ;  and  in  default 
thereof,  by  strength  of  age  and  sex. 

"  II.  If  those  who  perished  together  were  under  fifteen 
years,  the  oldest  shall  be  presumed  the  survivor. 

"  III.  If  they  were  all  above  sixty  years  of  age,  then  the 
youngest  shall  be  presumed  the  survivor. 

"  IV.  If  some  were  under  fifteen,  and  others  above  sixty, 
the  former  shall  be  presumed  the  survivors. 

"  V.  If  those  who  perished  together  were  over  the  age  of 
fifteen,  but  under  sixty,  the  males  shall  be  presumed  the 
survivors,  where  the  ages  are  equal  or  the  difference  does 
not  exceed  one  year. 

"  VI.  If  they  were  of  the  same  sex,  that  presumption 
shall  be  admitted  which  opens  the  succession  in  the  order 
of  nature.  Of  course,  the  younger  shall  be  considered  to 
have  survived  the  elder." 

According  to  Section  IV.  in  the  above  Code,  no  distinc- 
tion is  made  between  an  infant  and  a  man  of  sixty  years  ; 
yet  certainly  it  may  fairly  be  supposed  (as  remarked  by 
Dr.  Tidy)  that  the  latter  had  a  better  chance  of  life  than  the 
former.  The  Prussian  law  on  this  question  is  about  iden- 
tical with  the  Code  Napoleon.  These  principles  are  not  a 
part  of  the  law  in  the  United  States  or  England,  except  in 
Louisiana,  which  has  adopted  many  of  the  principles  of  the 
Code  Napoleon. 

Although  our  laws  are  not  decisive  on  questions  of  pre- 
sumption of  survivorship,  but  treat  them  as  questions  of 


PRESUMPTION    OF    SURVIVORSHIP.  75 

fact  depending  wholly  on  evidence,  and  in  the  absence  of 
all  evidence,  regarding  them  as  matters  incapable  of  being 
determined,  still,  there  are  matters  of  importance  connected 
with  each  case  as  it  presents  itself  which  deserve  consider- 
ation in  influencing  the  decision.  These  points  may  be 
considered  under  the  following  heads  : 

1.  Probabilities  Ajforded  by  the  Age. — Between  a  father 
and  a  child  under  puberty,  the  English  civil  law  decides 
the  farther  to  be  the  survivor.  Between  the  ages  of  fifteen 
and  sixty  there  is  no  probabihty.  Between  a  middle-aged 
man  and  one  under  fifteen  or  over  sixty,  the  probabilities 
are  in  favor  of  the  former.  Between  one  under  fifteen  and 
one  over  sixty,  the  former  is  deemed  the  survivor ;  but  the 
same  exception  might  be  taken  here  as  in  the  case  of  Section 
IV.  of  the  Code  Napoleon.  Between  two  under  fifteen,  the 
older  is  considered  the  survivor.  If  the  question  is  between 
a  mother  and  infant,  both  dying  in  childbed,  without  assist- 
ance, the  presumption  of  survivorship  is  in  favor  of  the 
mother,  because  the  child  might  be  still-born,  and  also 
because,  if  large,  its  life  might  be  endangered  by  delay,  and 
it  would  be  more  exposed  to  danger  without  assistance,  such 
as  strangulation  by  the  cord  or  suffocation  in  the  discharges 
of  the  mother. 

2.  Presumption  Afforded  by  the  Sex. —  The  presumption 
is  in  favor  of  the  male,  when  it  is  a  question  of  physical 
strength  and  courage,  as  when  a  man  and  woman  perish 
together  by  drowning,  or  some  other  casualty.  But  in 
particular  cases,  the  question  of  the  respective  health  of  the 
two  persons  might  have  to  be  considered.  When,  how- 
ever, it  is  a  question  of  passive  endurance,  especially  where 
insensibility  supervenes,  then  the  presumption  is  in  favor  of 
the  female. 


76  MEDICAL   JURISPRUDENCE. 

(3)  The  Cause  of  DeatJi,  as  affording  a  presumption  of 
survivorship.  In  death  from  asphyxia  (apnea),  as  in 
smothering,  or  breathing  noxious  gases,  as  women  require 
less  oxygen  than  men,  the  probabilities  are  in  favor  of  the 
former,  other  things  being  equal.  Thus,  it  is  stated  that 
in  Paris,  in  one  year,  there  occurred  three  hundred  and 
sixty  cases  of  poisoning  by  charcoal  vapors  ;  of  this  num- 
ber there  were  nineteen  instances  where  a  man  and  a 
woman  were  exposed  together,  and  of  these  only  three 
survived,  and  all  were  females.  Dr.  Beck  relates  the  case 
of  a  man,  wife,  and  child,  who  were  all  asphyxiated  while 
sleeping  in  a  room  which  was  exposed  to  the  vapors  of  a 
coal  stove.  In  the  morning  the  man  was  found  dead,  the 
child  dying,  but  the  woman  recovered. 

In  drowning  or  shipivrcck,  the  question  becomes  very 
complicated,  having  to  take  into  account  the  age,  sex, 
strength,  and  opportunity.  Thus,  men  being  stronger, 
more  likely  to  be  able  to  swim,  and  in  case  of  shipwreck, 
being  more  apt  to  be  on  deck,  and,  therefore,  in  a  better 
position  to  escape,  have  the  best  probabilities  for  survival ; 
but,  on  the  other  hand,  the  buoyancy  of  a  woman's  clothes 
might  support  her  in  the  water,  and  thus  save  her  life,  under 
possible  circumstances.  In  case  of  two  or  more  persons, 
all  males,  equally  exposed,  a  presumption  of  survivorship 
can  only  be  entertained  by  searching  for  bodily  injuries,  or 
other  weakening  causes,  which  would  necessarily  interfere 
with  the  individual's  exertions  to  save  his  life.  Here,  also, 
their  respective  swimming  capacities  would  have  to  be  con- 
sidered. 

If  the  question  be  on  the  survivorship,  in  the  case  of 
several  persons  exposed  to  excessive  cold,  the  amount  of 
clothing,  the  physical  condition,  and  the  immoderate  use 


PRESUMPTION    OF    SURVIVORSHIP.  // 

of  alcohol  must  all  be  considered  before  aniving  at  a  con- 
clusion. The  probabilities  would  here  be  in  favor  of  the 
strong  adult  over  the  very  young,  or  very  old  person,  and 
of  males  over  females.  The  debilitating  effects  of  poverty, 
entailing  a  bad  nutrition,  and  also  of  intoxication,  as  being 
especially  obnoxious  to  the  effects  of  cold,  should  not  be 
overlooked.  The  perishing  of  drunken  persons  on  a  cold 
winter's  night  is  a  familiar  occurrence.  In  relation  to  the 
effects  of  heat  it  may  be  remarked  that,  while  the  young 
and  old  suffer  more  from  cold  than  adults,  they  seem  able 
to  withstand  a  greater  amount  of  heat  than  the  latter. 

In  death  by  starvation,  the  general  principle  that  the 
young  require  more  food  than  the  aged  will  determine  the 
presumption  of  survivorship  to  be  in  favor  of  the  latter ; 
also  for  the  female,  rather  than  the  male.  Certain  circum- 
stances, however,  should  here  be  considered,  such  as  prox- 
imity to  water,  which  would  aid  in  sustaining  life  for  some 
time,  even  without  food. 


CHAPTER  V. 
PERSONAL  IDENTITY. 

The  medico-legal  consideration  of  the  subject  of  Personal 
Identity  is  much  more  important  than  it  may  appear  at  first 
sight.  The  question  is  often  raised  in  trials  and  it  may  con- 
stitute the  chief  link  in  the  chain  of  evidence.  Cases  of 
mistaken  identity  are  constantly  occurring  and  proofs  abund- 
ant might  be  adduced  to  show  that  innocent  persons  have 
frequently  been  made  to  suffer  judicial  penalties,  simply 
through  an  error  of  this  nature.  Should  an  alleged  child, 
or  other  claimant,  present  his  claim  to  an  inheritance,  he 
must  first  establish  his  identity  before  taking  further  steps 
in  the  suit.  If  an  individual  is  assaulted  or  robbed, 
he  will  be  required  to  identify  his  assailant  before  he  can 
successfully  prosecute  him.  Again,  a  person,  after  many 
years'  absence  in  foreign  climes,  returns  home  to  claim  his 
rightful  property  or  title ;  but  he  is  so  changed  as  to  be 
unrecognized  by  his  nearest  relatives  ;  he  must  be  able  to 
prove  his  identity  before  the  courts  before  his  claim  can  be 
sustained.  In  relation  to  persons  found  dead  —  whether  in 
cases  of  recent  death,  where  the  body  has  undergone  but 
little  change,  or  years  after  the  decease,  where  nothing  re- 
mains but  the  skeleton  —  the  question  of  personal  identity 
acquires  the  most  intense  interest,  especially  in  a  trial  for 
murder,  where  it  becomes  essential  to  estabhsh  the  identity 
of  the  alleged  victim. 

The  aid  of  the  physician  is  not  so  frequently  invoked  for 
proving  the  identity  of  the  living,  since  this  can  generally 

78 


IDENTITY    OF    THELIVING.  79 

be  established  as  satisfactorily  by  friends  and  neighbors. 
Still,  there  may  be  occasions  of  unusual  complexity  in  which 
a  professional  opinion  may  become  requisite,  as,  for  example, 
to  verify  certain  deformities,  fractures,  scars  and  other  marks 
about  the  person,  when  these  constitute  the  evidences  on 
which  the  identification  may  depend. 

The  subject  will  be  considered  under  the  two  divisions  of 
(i)  The  Identity  of  the  Living  and  (2)  The  Identity  of  the 
Dead. 

I.  The  Identity  of  the  Living. — This  may  usually  be 
established  by  the  direct  evidence  of  witnesses  who  have 
known  the  individual  sufficiently  long  to  have  a  distinct 
recollection  of  his  personal  appearance ;  such  is  the  testi- 
mony of  relatives,  friends,  and  acquaintances.  Although 
among  the  myriads  of  the  human  family  it  is  very  rare  to 
find  two  persons  exactly  alike  in  all  points,  yet  remarkable 
instances  do  occasionally  occur  where  the  personal  resem- 
blance is  so  striking  as  to  baffle  even  the  skill  of  the  detec- 
tive, and  this  resemblance  has  been  made  still  stronger  by 
the  existence  of  similar  marks,  cicatrices  or  certain  pecu- 
liarities of  structure  in  both  individuals.  Some  striking 
illustrations  might  be  given  of  the  extreme  difficulty  — 
amounting,  at  times,  to  an  impossibility  —  of  deciding  the 
question,  which  also  goes  to  show  how  easily  witnesses  may 
be  mistaken  in  their  evidence  on  this  subject.  Only  two 
will  be  here  referred  to. 

In  the  year  1560,  the  celebrated  case  oi  Martin  Guerre 
and  Armand  dii  Tilh  was  tried  before  the  Parliament  of 
Toulouse.  Martin  had  been  absent  from  his  home  for 
eight  years,  when  the  person  named  du  Tilh  appeared  and 
represented  himself  as  the   long-absent  man.     So  strong 


80  MEDICAL    JURISPRUDENCE. 

was  the  resemblance,  that  his  statement  was  universally 
accepted  by  all  of  Guerre's  family,  including  his  wife,  four 
sisters,  and  two  brothers-in-law,  among  whom  he  lived  un- 
suspected for  three  years.  About  this  time,  however,  some- 
thing occurred  to  excite  suspicions  as  to  the  true  character 
of  the  supposed  husband  and  brother,  when  he  was  arrested, 
and  brought  before  the  tribunal,  on  a  charge  of  fraud. 
Upon  his  examination  he  gave  satisfactory  answers  to  the 
most  minute  questions  in  relation  to  Guerre's  former  life. 
Some  one  hundred  and  fifty  witnesses  were  examined  dur- 
ing the  investigation,  of  whom  between  thirty  and  forty 
testified,  from  a  life-long  acquaintance,  that  the  prisoner 
was  Martin  Guerre  ;  while  about  the  same  number  swore 
positively  that  he  was  Armand  du  Tilh,  whom  they  well 
knew ;  and  over  sixty,  who  knew  them  both,  declared  that 
they  were  unable  to  say  which  the  prisoner  was.  Finally, 
however,  the  real  Martin  appeared  upon  the  scene,  when 
he  was  immediately  recognized.  The  four  sisters  who  had 
previously  testified  that  du  Tilh  was  their  real  brother  now 
admitted  their  error,  and  acknowledged  the  distinction. 
There  being  now  no  doubt  of  the  guilt  of  the  prisoner,  he 
was  condemned,  and  afterward  executed. 

The  other  instance  is  afforded  in  the  recent  famous  Tich- 
borne  case,  in  which  a  person  named  Orton,  with  various 
aliases,  undertook  to  personate  an  English  baronet,  heir  to 
a  large  entailed  estate.  So  successful  was  his  scheme  that 
"  he  was  sworn  to  be  Sir  Roger  Tichborne  by  eighty-five 
witnesses,  among  whom  were  Sir  Roger's  mother,  the 
family  solicitor,  one  baronet,  six  magistrates,  one  general, 
three  colonels,  one  major,  two  captains,  thirty-two  non- 
commissioned officers  and  privates  of  the  army,  four  clergy- 
men, seven  tenants  of  the  Tichborne  estates,  and  seventeen 


IDENTITY    OF   THE    LIVING.  Ol 

sei-vants  of  the  family."  The  claimant  also  gave  proof  of 
"  a  fish-hook  wound  on  the  eye,  of  a  mark  of  bleeding  on 
the  ankle,  and  of  a  peculiar  scar  on  the  head,"  all  of  which 
the  genuine  Sir  Roger  possessed.  The  case,  however, 
broke  down  on  cross-examination,  many  circumstances 
being  proved  against  the  claimant,  which  need  not  be  here 
enumerated.  Suffice  it  to  say  that  a  verdict  was  taken 
against  him,  and  that  an  indictment  was  found  against  him 
for  perjury. 

Now,  as  a  fair  inference  from  the  above  two  instances  - 
and  other  remarkable  cases,  we  may  assume  that  appear- 
ances are  not  conclusive  evidences  of  personal  identity, 
because  these  appearances  convey  different  impressions  to  • 
different  observers ;  and  as  a  result  of  this  discrepancy,  we 
must  admit  the  fact  that  "  a  large  proportion  of  ordinary 
persons  are  very  untrustworthy  witnesses  to  identity  when 
dependent  on  appearances  alone.  They  are,  from  nature 
or  habit,  incapable  of  appreciating  form,  and  form  alone  is 
the  unerring  proof  of  personal  identity.  The  difficulties  in 
the  way  of  identification,  more  especially  of  the  dead,  are 
to  them  insuperable."  To  this  inherent  difficulty  on  the 
part  of  the  witnesses  may  be  added  their  want  of  previous 
training  as  minute  observers,  and  also  the  well-known  fact 
of  the  adroitness  of  criminals  at  personal  disguisement. 

A  second  means  of  establishing  the  identity  of  the  living, 
especially  in  a  criminal,  is  by  certain  peculiarities  in  the 
appearance,  which  are  noticed  at  the  time  of  the  commission 
of  the  crime,  and  which  are,  therefore,  apt  to  leave  a  strong 
impression  on  the  senses,  such  as  (a)  size,  when  the  indi- 
vidual is  very  tall  or  very  short,  very  corpulent,  or  very 
slim  ;  whether  lame,  or  otherwise  deformed ;  (d)  dress,  when 
a  portion  —  sometimes  a  mere  shred  —  of  the  prisoner's  dress 
7 


82  MEDICAL  JURISPRUDENCE. 

is  discovered  near  the  seat  of  the  crime,  or  which  may  have 
been  retained  in  the  grasp  of  his  victim,  and  which  exactly 
corresponds  with  the  rest  of  the  garment  found  on  his 
person,  or  in  his  own  house. 

A  third  means  of  identification  is  afforded  by  the  voice. 
Peculiarity  of  the  voice  (such  as  depth  or  shrillness,  lisping 
or  stammering)  always  makes  a  strong  impression  upon 
those  who  hear  it,  and  constitutes  a  valuable  aid  in  personal 
identification. 

Fourthly,  the  presence  of  certain  peculiar  marks,  either 
natural  or  acquired,  about  the  person,  often  affords  material 
aid  in  establishing  identity.  These  marks  compnse  moles, 
nevi,  scars,  cicatrices,  deformities,  fractures,  tattoo-marks, 
etc.  Such  marks  are  usually  well  known  and  remembered 
by  relatives  and  friends  of  the  individual,  who  can  usually 
identify  them.  Some  of  these  remain  upon  the  body  during 
life ;  others  gradually  decline  and  fade  away.  In  relation 
to  tattoo-marks,  Casper's  experience  leads  to  the  inference 
that  some  of  them  (the  red  ones)  are  gradually  obliterated 
by  time,  while  the  black  and  purple  ones  are  more  perma- 
nent. A  cicatrix  is  permanent  during  life,  if  there  has  been 
any  original  loss  of  substance.  Even  the  cicatrix  made  by 
the  lancet  in  venesection,  at  the  bend  of  the  arm,  usually 
remains  during  life.  It  may  not  always  be  distinguished 
from  the  surrounding  skin,  unless  the  part  be  smartly 
rubbed,  when  the  white  scar  is  immediately  manifested  on 
the  red  surrounding  surface.  Caution  should  be  observed 
against  too  strong  reliance  upon  scars  as  a  means  of  iden- 
tity, since  these  may,  at  times,  be  discovered  upon  another, 
precisely  similar,  both'as  to  form  and  situation. 

Under  this  head  may  be  mentioned  the  appearance  of  the 
hands   (whether  hard  and    horny,   or    soft    and    pliant,    or 


IDENTITY   OF   THE    LIVING.  83 

whether  stained  in  a  peculiar  manner),  as  often  indicating 
the  nature  of  the  occupation  of  the  individual. 

In  no  small  number  of  cases  now  recorded,  the  teeth 
have  been  essential  links  in  the  chain  of  identification.  Es- 
pecially in  this  the  case  when  the  individual  has  been  under 
the  care  of  a  dentist,  teeth  extracted,  irregularity  of  tooth- 
line,  fillings,  and  artificial  teeth  all  being  identifiable  by  the 
dentist  who  did  the  work. 

Photographs  and  other  portraits  of  the  suspected  person 
are  sometimes  useful  aids  in  the  identification  of  the  living, 
as  well  as  of  the  dead ;  but  caution  is  requisite  here,  since 
the  art  of  the  photographer  in  the  touching  up  of  the  pic- 
ture frequently  makes  it  an  unfaithful  representation  of  the 
features. 

As  bearing  upon  this  subject,  it  may  be  proper  to  say  a 
few  words  upon  vision  and  hearing.  The  limits  of  normal 
vision  or  healthy  sight,  unassisted  by  instruments,  in  a  per- 
fectly clear  atmosphere,  are  stated  to  be  as  follows  : 

5  feet,  the  range  of  distance  is     2.96  miles. 

5.91       " 

9-35       " 
13.2 

29.5 
41.8 
94 

It  follows  from  this  that  a  man  of  ordinary  height  may 
be  seen  on  level  ground  at  a  distance  of  two  or  three  miles 
on  a  clear  day  ;  but  this  is  very  different  from  recognition  of 
the  person  so  as  to  identify  him.  The  effects  of  age  upon 
the  acuteness  of  vision  are  considered  by  Dr.  De  Gueret  to 
be  as  follows  : 

At  fifty  years  it  is  diminished  one  fifth  ;  at  sixty  years, 


At  a  height  of 

5 

20 

50 

100 

500 

1000 

5000 

84  MEDICAL   JURISPRUDENCE. 

one  fourth  ;  at  seventy  years,  one  third ;  at  eighty  years, 
one  half.  In  other  words,  if  a  man  of  thirty  or  forty  could 
distinguish  an  object  at  one  hundred  feet  distance,  at  sixty 
years  of  age  he  could  not  recognize  it  further  off  than 
seventy-five  feet,  or  at  eighty  years  at  fifty  feet. 

The  recognition  of  persons  at  a  nearer  or  greater  distance 
is  afforded  by  their  stature,  gait,  complexion,  color  of  the 
hair  and  eyes,  and  peculiarities  of  appearance.  According 
to  the  above  authority,  the  best-known  persons  can  be 
recogized  often  with  difficulty,  in  broad  daylight,  at  one 
hundred  meters,  or  about  one  hundred  and  nine  yards. 
Less  known  persons  may  be  recognized,  in  broad  daylight, 
at  sixty  to  one  hundred  yards  ;  and  people  who  are  almost 
strangers,  and  who  have  no  personal  peculiarities,  at  twenty-' 
seven  to  thirty-three  yards.  By  the  clearest  moonlight, 
the  best-known  persons  cannot  be  recognized  further  off\^ 
than  sixteen  or  seventeen  yards.  By  starlight,  recognition ' 
cannot  be  effected  beyond  ten  to  thirteen  feet.  The  light 
of  a  flash  of  lightning  enabled  a  lady,  on  her  passage  home 
from  India,  to  see  distinctly  the  features  of  a  man  who  was 
robbing  her  trunk  in  the  cabin  of  a  vessel,  on  a  very  dark 
night ;  and  authentic  instances  are  given  where,  by  the  flash 
of  a  pistol  or  gun,  sufficient  light  was  momentarily  afforded 
to  enable  not  only  an  assailant  to  be  recognized,  but  like- 
wise the  color  and  appearance  of  his  horse. 

The  distance  at  which  sounds  (such  as  the  report  of  a 
gun  or  pistol)  continue  to  be  audible  cannot  be  determined 
with  accuracy,  since  it  depends  upon  the  direction  of  the 
wind,  the  condition  of  the  atmosphere  as  to  moisture,  and 
other  disturbing  sounds.  The  velocity  of  sound  may  be 
stated  to  be,  on  an  average,  1,135  feet  per  second,  which  is 
about  13  miles  a  minute,  or  one  mile  in  about  4^  seconds. 


IDENTITY   OF   THE    LIVING.  85 

II.  The  Identification  of  the  Dead. — This  may  have  ref- 
erence (i)  to  the  body  recently  dead,  but  entire;  (2)  when 
the  body  has  been  mutilated  and  only  parts  of  it  are  sub- 
mitted, and  (3)  when  the  soft  parts  have  disappeared  by 
putrefaction  and  the  skeleton  only  remains,  or  where  de- 
tached bones  merely  have  been  discovered. 

When  the  death  has  but  recently  occurred  and  the  body 
is  unmutilated,  most  of  the  same  general  methods  of  estab- 
lishing identity  are  available  as  have  already  been  mentioned 
in  the  case  of  the  living — such  as  the  testimony  of  relatives 
and  acquaintances  as  to  the  personal  appearance  of  the  de-' 
ceased,  certain  marks  upon  the  person,  as  nevi,  moles,  cica- 
trices, tattoo-marks,  fractures,  deformities,  etc.  Photographs 
and  other  portraits  are  here  also  admissible,  although  by  no 
means  always  reliable  proofs. 

If  the  body  has  been  subjected  to  mutilation  after  death 
and  the  several  portions  removed  to  a  distance  from  one 
another  and  some  of  them  even  destroyed,  as  is  sometimes 
done  by  a  murderer  with  a  view  to  escape  detection,  the 
difficulty  of  identification  is,  of  course,  very  much  increased. 
Nevertheless,  if  the  disconnected  parts  can  be  recovered,  or 
even  a  portion  of  them,  it  will  always  be  possible  for  a 
skilled  anatomist  so  to  readjust  them  as  to  reconstruct  the 
body,  so  to  speak,  by  making  the  proper  allowances  for 
the  missing  parts  and  comparing  these  with  other  average 
specimens  of  a  similar  kind.  Several  striking  examples  of 
this  character  have  been  recorded.  One  of  these  is  the 
well-known  case  of  Dr.  Parkman,  who  was  murdered  by 
Dr.  Webster,  in  Boston,  Mass.,  about  forty  years  ago. 
After  the  death  of  his  victim  Dr.  Webster  attempted  to  de- 
stroy all  evidences  of  the  deed  by  cutting  up  the  body  into 
fragments,  some  of  which  were  burned  in  a  grate,  some  im- 


86  MEDICAL  JURISPRUDENCE. 

mersed  in  chemicals,  and  others  packed  away  in  boxes  in 
distant  parts  of  the  building.  On  the  discovery  of  these 
remains,  a  week  after  the  murder,  the  portions  of  the  body 
were  accurately  examined  by  a  skilled  anatomist.  It  was 
proven  that  they  were  human  remains,  belonging  to  one 
and  the  same  body  ;  of  the  male  sex  ;  and  that  they  had  not 
been  dissected  for  anatomic  purposes,  but  cut  and  hacked 
in  different  directions,  for  the  object,  evidently,  of  mutila- 
tion. On  restoring  these  disjointed  parts  in  situ,  and  sup- 
plying the  deficient  portions,  it  was  found  that  the  proper 
measurements  agreed  closely  with  those  of  the  missing  Dr. 
Parkman.  This  circumstance,  together  with  the  discovery 
of  certain  marks  of  identity  about  the  teeth  and  jaws  (the 
head  had  been  almost  completely  destroyed  by  fire ), 
afforded  sufficient  evidence  of  the  personal  identity  of  the 
missing  man  to  enable  the  jury,  on  the  trial  of  Dr.  Web- 
ster, to  find  a  verdict  of  guilty.  Another  instance  of  a 
somewhat  similar  nature  is  recorded  by  Professor  Taylor. 
A  number  of  years  ago  a  murder  was  committed  in  London, 
on  the  river  Thames,  and  shortly  afterward  a  package  con- 
taining mutilated  human  remains  was  discovered  on  one 
of  the  abutments  of  Waterloo  Bridge.  The  murderer  had 
no  doubt,  intended  to  throw  the  bundle  into  the  river  ;  but 
it  had  lodged  on  the  projection  in  its  descent.  Dr.  Taylor 
was  requested  to  examine  and  identify  these  mutilated 
remains  ;  and  when,  after  great  difficulty,  the  parts  were 
brought  together  and  found  to  fit,  the  body  was  identified 
as  that  of  a  man  who  had  recently  disappeared  from  a 
vessel  on  the  river  —  a  Swedish  sailor.  One  of  the  most 
remarkable  cases  of  this  class  was  recently  (1897)  tried  in 
Chicago,  111.  The  defendant,  Luetgert,  was  a  sausage- 
maker,  and  was  accused  of  having  murdered  his  wife  and 


IDENtiFicATiON    OF    THE    DEAD.  8/ 

destroyed  her  body  by  solution  in  caustic  soda  in  a  vat  in 
his  manufactory.  Some  small  bones  and  articles  of  jewelry 
were  found  in  the  vat.  The  trial  lasted  many  days,  but 
ended  in  a  disagreement  of  the  jury.  The  contention  of 
the  prosecution  that  the  bones  found  were  human  was  com- 
bated by  experts  called  by  the  defense. 

When  the  question  of  identity  relates  to  the  skeleton 
merely,  or  only  to  portions  thereof,  the  answer  cannot  be 
always  satisfactory,  and  the  medical  jurist  has  need  of  much 
caution  and  reserve  before  giving  a  positive  opinion. 

The  very  first  thing  for  him  to  determine  is  whether  the 
bones  submitted  to  his  inspection  are  human  bones  or  those 
of  some  of  the  inferior  animals.  Doubtless,  if  the  entire 
skeleton  be  discovered,  there  need  be  no  uncertainty  about 
the  matter ;  but  if  only  a  single  bone  or  two  be  found,  a 
mistake  may  easily  be  made,  except  by  a  practiced  anatomist 
and  osteologist.  Indeed,  many  ludicrous  blunders  are  re- 
corded of  persons,  of  otherwise  good  medical  education, 
mistaking  the  bones  of  the  ox,  horse,  dog,  pig,  and  goat  for 
those  of  the  human  subject.  But  may  not  something  be 
learned  by  the  aid  of  chemistry  or  the  microscope  ?  The 
reply  must  be  generally  in  the  negative.  Certainly,  the 
bones  of  the  aged  do  contain  more  calcareous  matter  than 
those  of  the  young,  and  consequently  present  a  somewhat 
different  appearance  under  the  microscope.  But  human 
bones  have  the  same  general  chemical  composition  as  those 
of  the  lower  animals.  Bone-cells  or  corpuscles  vary  some- 
what in  size  in  the  different  orders  of  animals,  being  largest 
in  reptiles,  smallest  in  birds  and  mammals,  and  intermediate 
in  fishes.  In  this  respect  there  is  an  analogy  with  the  size 
of  the  blood  corpuscles  in  these  different  orders  ;  but  these 
are  only  generalizations,  and  would  be  of  little  practical  use 


88  Medical  jurisprudence. 

in  individual  instances.  To  be  sure,  the  microscope  will 
enable  us  to  determine  the  fact  of  any  specimen  submitted 
being  bone,  or  not,  by  the  presence  or  absence  of  the  bone- 
cells  ;  but  it  can  go  no  further,  inasmuch  as  it  cannot  dis- 
tinguish the  bone-cell  of  a  man  from  that  of  a  mouse  or  of 
an  elephant. 

If  the  skull  is  the  only  portion  of  the  skeleton  submitted 
for  examination,  there  can  usually  be  no  difficulty  in  recog- 
nizing it  as  human  ;  the  only  doubt  that  might  arise  would 
be  the  possibility  of  its  belonging  to  one  of  the  higher  order 
of  (anthropoid)  apes ;  but  even  here  there  are  important 
differences  which  would  not  be  overlooked  by  one  skilled 
in  comparative  anatomy  and  osteology.  The  further  ques- 
tion, whether  from  the  examination  of  a  skull  simply,  it  is 
possible  to  decide  to  what  race  the  individual  belonged,  — 
Caucasian  or  otherwise,  —  we  do  not  thing  can  be  answered 
with  absolute  certainty.  Doubtless,  well-marked  typical 
skulls  may  be  identified  as  belonging  to  some  particular 
race,  c.  g.,  the  Negro  or  Caucasian  ;  but  we  must  remember 
that  the  points  of  distinction,  which  in  well-marked  speci- 
mens serve  to  separate  these,  shade  away  in  many  instances 
so  as  to  make  it  extremely  difficult,  if  not  impossible,  to 
give  a  medico-legal  opinion  in  an  isolated  case. 

Another  important  point  is  to  ascertain  whether  all  the 
bones  submitted  for  inspection  belong  to  one  and  the  same 
skeleton.  The  mere  fact  of  their  being  discovered  together 
does  by  no  means  necessarily  prove  it,  since  they  might 
have  been  so  placed  either  accidentally  or  with  the  design 
of  eluding  detection  of  some  crime. 

In  the  identification  of  the  dead  by  means  of  the  skele- 
ton or  by  detached  bones,  the  three  leading  points  to  deter- 
mine are  (i)  the  age,  (2)  the  sex,  and  (3)  the  stature. 


IDENTIFICATION    OF    MUTILATED    REMAINS.  89 

I.  The  Age. — This  can  generally,  in  young  subjects,  be 
pretty  accurately  determined  by  the  development  of  the 
teeth  and  by  the  progress  of  ossification  in  the  different 
bones.  In  the  skeletons  of  new-born  children,  and  before 
the  teeth  have  appeared,  it  may  become  important  for  the 
medical  jurist  to  be  able  to  decide  upon  the  age  in  order 
either  to  rebut  or  confirm  a  charge  of  infanticide.  It  is 
authoritatively  stated  that  in  the  jaws  of  a  child  at  full 
term  there  will  always  be  found  the  rudiments  of  twenty- 
four  teeth  —  twenty  primary  teeth  and  four  permanent 
molars.  Hence,  if  only  the  jaws  of  an  infant  be  discovered, 
medical  evidence  of  its  probable  age  may  be  given.  The 
average  date  of  the  eruption  (cutting)  of  the  teeth  is,  ac- 
cording to  Mr.  Bell,  as  follows  :  The  four  central  incisors 
appear  from^e^^  to  eight  months  after  birth;  the  four  lateral 
incisors,  from  se'ven  to  ten  months ;  the  four  anterior 
molars,  from  tzvelve  to  sixteen  months  ;  the  four  cuspidati, 
from  fourteen  to  tzventy  months  ;  and  the  four  posterior 
molars  from  eighteen  months  to  three  years.  Between  six 
and  seven  years  the  jaws  contain  forty-eight  teeth  —  twenty 
temporary  ones  in  a  perfect  state  of  development,  and 
twenty-eight  permanent  ones  imperfectly  developed  and 
placed  behind  the  temporary  teeth  which  they  are  to  re- 
place. According  to  Mr.  Saunders,  the  order  in  which  the 
permanent  teeth  make  their  appearance  is  as  follows  :  At 
seven  years,  the  four  anterior  molars ;  at  eight-  years,  the 
four  central  incisors;  at  nine  years,  the  four  lateral  incisors  • 
at  ten  years,  the  four  anterior  bicuspids  ;  at  eleven,  the  four 
posterior  bicuspids ;  at  twelve  to  twelve  and  a  half  years 
the  four  cuspids  ;  and  at  thirteen  to  fourteen  years,  the  four 
second  molars  —  making  the  whole  number  of  permanent 
teeth  at  this  period  tiventy-eight.     The  four  remaining  (pes- 


go  MEDICAL   JURISPRUDENCE. 

terior  molars)  teeth — called  wisdom  teeth  —  do  not  usually 
appear  until  from  eighteen  to  twenty-one  years  of  age.  As 
a  rule,  the  teeth  of  the  lower  jaw  are  cut  first,  but  there 
are  many  exceptions  ;  nor  must  it  be  forgotten  that  irregu- 
larities often  occur  as  to  the  order  of  their  appearance. 
The  above  description  is  intended  to  apply  only  to  the 
average  cases. 

To  cite  one  or  two  examples  in  illustration  of  the  medico- 
legal application  of  the  foregoing  rules  :  suppose  the  skull 
of  a  child  was  discovered,  in  the  jaws  of  which  were 
/ze'^/?7£' permanent  teeth  —  eight  incisors  and  four  molars; 
we  should  decide  the  age  to  be  about  7/zne  years.  If  the 
jaws  contained  twcnty-foiir  permanent  teeth — eight  incisors, 
four  molars,  eight  bicuspids,  and  four  cuspids,  we  should 
conclude  the  age  to  be  about  thirteen  years  ;  and  so  on. 
It  is  proper  here  to  remark  that  there  are  two  diseases 
which  affect  the  growth  of  the  teeth,  viz.,  rickets  and  syph- 
ilis. In  a  rickety  child  the  first  teeth  do  not  usually 
appear  until  after  the  twelfth  month,  whereas  in  cases  of 
congenital  syphilis  the  teeth  appear  prematurely  —  before 
the  sixth  month  ;  but  they  present  a  peculiar  notched  ap- 
pearance, and  they  are  apt  to  be  brittle  and  to  crumble 
away  easily. 

The  progress  of  ossification  in  the  different  bones  of  the 
skeleton  affords  an  additional  test  of  its  age,  especially  in 
early  life.  According  to  Beclard,  the  degree  of  ossification 
in  the  lower  epiphysis  of  the  femur  affords  the  most  certain 
criterion  of  the  age  of  the  fetus  and  of  the  new-born  child. 
Thus,  if  no  ossific  deposit'  can  be  seen  in  this  cartilaginous 
epiphysis,  it  is  certain  that  the  fetus  has  not  attained  to  the 
eighth  month  of  uterine  life.  If  the  osseous  deposit  is  as 
large  as  a  poppy-seed,  it  is  probably  in  the  ninth  month  of 


DETERMINATION    OF    THE    AGE.  9I 

fetal  existence  ;  and  if  it  has  acquired  the  diameter  of  a 
line  and  a  quarter,  to  one  and  a  half,  it  has  reached  the  full 
period.  If  the  point  of  ossification  measures  three  lines  or 
more,  it  may  be  assumed  that  the  child  had  survived  its 
birth  some  little  time. 

The  average  length  of  the  skeleton  of  a  new-born  child 
is  about  sixteen  inches.  At  the  end  of  the  first  year,  ossi- 
fication has  commenced  at  the  extremities  of  most  of  the 
long  bones  ;  and  this  progressively  advances  from  year  to 
year  until  the  whole  process  is  completed,  and  the  epiphyses 
of  all  the  long  bones  become  united  to  their  shafts  at  full 
maturity,  which,  in  the  male,  may  be  considered  to  be 
twenty-four  years,  and  in  the  female,  twenty-two  years. 
After  this  period,  or  when  ossification  is  once  completed, 
it  is  difficult  to  determine  the  precise  age  by  an  examina- 
tion of  the  bones  of  the  skeleton.  It  should,  however,  be 
remembered  that  the  different  bones  of  the  sternum  do  not 
unite  until  about  the  fortieth  or  forty-fifth  year ;  and  union 
between  the  sacrum  and  os  coccygis  is  not  usually  com- 
pleted until  fifty-five  or  sixty  years  of  age. 

In  old  age,  the  bones  become  lighter  in  weight  and  more 
brittle,  from  the  loss  of  animal  matter.  They  are  also 
darker  in  color ;  and  the  flat  bones  become  thinner,  from 
the  absorption  of  the  diploe.  In  the  skull  of  the  aged,  the 
sutures  are  more  or  less  obliterated  ;  and  the  remaining 
teeth  present  a  worn  appearance,  and  a  yellowish  color.  If 
the  teeth  have  been  lost  (as  is  usually  the  case,  at  least  in 
this  country),  the  alveolar  processes  become  absorbed,  and 
the  lower  jaw  undergoes  a  well- marked  change  in  its  appear- 
ance, consisting  of  the  widening  of  the  angle  at  its  neck,  and 
the  shortening  of  the  vertical  diameter  of  its  body,  or  width, 
which  imparts  the  characteristic  senile   expression    to  the 


92  MEDICAL    JURISPRUDENCE. 

mouth  of  the  aged.  The  discovery  of  such  a  jawbone 
would  positively  determine  the  age  to  be  about  seventy 
years  or  over. 

The  presence  or  absence  of  certain  teeth  in  the  head  has 
frequently  been  the  means  of  determining  the  identity  of 
the  body.  So,  also,  the  presence  of  artificial  teeth,  with 
their  mechanical  appendages,  has  at  times  furnished  the 
strongest  corroborative  evidence  in  such  identification,  as 
in  the  celebrated  Parkman-Webster  case,  already  alluded  to, 
in  which  the  artificial  teeth,  discovered  undestroyed  by  the 
fire  in  the  grate,  where  the  head  had  been  burnt  up,  were 
positively  identified  by  the  dentist  who  had  manufactured 
and  fitted  them  some  years  before.  So,  likewise,  the  remains 
of  the  Marchioness  of  Salisbury,  discovered  among  the 
burnt  ruins  of  Hatfield  House,  were  identified  by  the  jaw- 
bone having  gold  appendages  for  artificial  teeth  (Guy).  The 
importance  of  the  teeth  as  a  means  of  identification  is  shown 
in  the  case  of  the  late  French  Prince  Imperial,  killed  in 
battle  ;  his  body  had  been  so  much  disfigured  by  his  savage 
assailants  that  its  identification  would  have  been  extremely 
difficult  but  for  certain  peculiarities  about  his  teeth, 

II.  The  Sex. — This  can  usually  be  determined  from  the 
skeleton,  if  entire,  without  much  difficulty.  The  male  and 
female  skeleton  present  many  well-defined  points  of  differ- 
ence, which  are  described  in  all  anatomic  works.  The 
corresponding  bones  of  the  two  differ  in  size,  weight, 
strength,  and  prominence  of  their  ridges  and  protuberances 
which  mark  the  points  for  the  insertion  of  muscles.  There 
are  also  certain  recognized  differences  in  the  head  and 
thorax ;  but  it  is  in  the  pelvis  that  the  most  characteristic 
distinctions  are  observed.     The  male  pelvis  is  narrower  and 


DETERMINATION    OF    SEX.  93 

deeper  than  that  of  the  female.  In  the  latter,  the  iliac 
bones  are  more  spread  out,  and  flatter,  which  renders  the 
superior  part  of  the  pelvis  more  capacious  ;  the  sacrum  is 
broader,  and  turned  more  backward  ;  the  arch  of  the  pubis 
is  much  wider.  The  greatest  diameter  is  the  bilateral  ; 
whereas  in  the  male,  the  antero-posterior  is  the  greater. 
The  foramen  ovale  is  triangular  in  the  female  ;  in  the  male, 
it  is  more  oval.  Owing  to  the  greater  breadth  of  the  female 
pelvis,  the  acetabula  are  farther  apart  than  in  the  male.  It 
is  to  be  understood  that  these  peculiarities  in  the  female 
pelvis  are  not  clearly  exhibited  before  the  period  of  puberty. 
From  a  fragment  of  a  bone  it  would  certainly  be  hazardous 
to  undertake  to  determine  the  sex ;  and  care  should  be 
exercised  in  giving  an  opinion  in  such  a  case. 

III.  The  Stature.  —  If  the  whole  skeleton  has  been  pre- 
served, and  none  of  the  ends  of  the  long  bones  have  been 
lost  by  decay,  the  original  height  may  be  calculated  with 
tolerable  accuracy  by  arranging  the  bones  in  situ,  and  adding 
an  inch  and  a  half  to  two  inches  to  the  entire  length  of  the 
skeleton,  to  supply  the  loss  of  the  soft  parts.  But  even  here 
perfect  accuracy  cannot  be  attained,  chiefly  on  account  of 
variations  in  the  curve  of  the  spinal  column  in  different  indi- 
viduals. Dr.  Dwight  assumes,  as  the  result  of  numerous 
observations,  that  the  total  height  of  the  intervertebral  carti- 
lages is  25.6  per  cent,  of  the  entire  length  of  the  spine.  As 
a  collateral  aid  in  estimating  the  stature,  we  may  regard  as 
correct  the  generally  accepted  rule  that  the  top  of  the 
symphysis  of  the  pubes  is  about  the  center  of  the  body  in 
average  women  ;  while  in  men,  the  center  is  a  little  below 
the  symphysis. 

The  attempt  has  frequently  been  made  to  estimate  the 


94  MEDICAL   JURISPRUDENCE. 

height  of  the  body  from  a  study  of  the  individual  long 
bones  of  the  skeleton  ;  but  no  reliance  can  be  placed  upon 
such  comparisons,  inasmuch  as  there  is  considerable  varia- 
tion in  the  length  of  these  bones  in  skeletons  of  the  same 
stature.  The  so-called  "rules  of  proportion  "  of  certain 
writers  cannot  be  regarded  as  by  any  means  certain  or 
authoritative.  In  case  the  skull  is  wanting,  the  rule  laid 
down  by  Dr.  Gould  is  "to  find  the  height  of  the  spine  of 
the  seventh  cervical  vertebra  from  the  ground,  and  add  to 
this  9.95  inches,  which  is  the  average  height  from  this 
point  to  the  top  of  the  head."  De  St.  Lucca  states  that 
there  is  a  general  proportion  between  the  different  bones  of 
the  body  and  the  stature,  and  that  an  approximate  esti- 
mate of  the  stature  may  be  had  by  measuring  the  length  of 
the  first  phalanx  of  the  middle  finger,  thus  :  this  phalanx  is 
equal  in  length  to  one  fourth  that  of  the  whole  hand,  in- 
cluding the  carpus  ;  and  the  carpal  and  metacarpal  bones 
together  represent  one  half  of  the  hand.  The  arm  may  be 
divided  into  five  parts,  of  which  two  were  included  in  the 
humerus,  two  in  the  fore  arm,  and  one  in  the  hand.  The 
total  length  of  the  hand  is,  therefore,  one  fifth  of  the  arm. 
Double  the  length  of  the  arm  (or  the  two  arms  stretched' 
out  horizontally),  added  to  the  length  of  the  two  clavicles, 
together  with  the  transverse  diameter  of  the  sternum,  is 
equivalent  to  the  whole  length  of  the  body.  In  applying 
this  rule  to  practice,  however,  we  must  not  forget  that  the 
length  of  the  hand,  and  especially  that  of  the  fingers,  varies 
materially  in  persons  of  the  same  height ;  and  so  trifling  a 
variation  in  the  first  phalanx  of  the  middle  finger  as  the 
one  sixteenth  of  an  inch  would,  according  to  this  method 
of  calculation,  figure  up  as  great  a  difference  in  the  total 
result,  for  the  height  of  th?  whole  body,  as  two  and  a 
half  inches, 


IDENTIFICATION    OF    THE   STATURE.  95 

The  existence  of  fractures,  deformities,  and  callus  in  a 
skeleton  sometimes  affords  valuable  aid  in  its  identification, 
even  many  years  after  death.  In  relation  to  the  produc- 
tion of  callus,  it  is  well  understood  that  this  substance  is 
the  result  of  the  reparative  processes  in  bone,  and  that  its 
presence  is  a  certain  indication  that  some  time  must  have 
elapsed  between  the  injury  to  the  bone  and  the  death  of 
the  individual.  On  the  other  hand  the  total  absence  of 
callus  on  a  fractured  bone,  indicating  that  no  time  had  been 
given  for  the  process  of  repair,  would  be  very  good  evi- 
dence that  the  injury  was  the  immediate  precursor  of  death, 
and  if  on  the  skull,  the  probable  cause  of  death.  An  in- 
structive illustration  of  this  is  given  by  Taylor  in  the  case 
of  an  Englishman,  who  was  tried  in  India  for  the  murder 
of  a  native  who  had  been  beaten  with  a  stick,  the  allega- 
tion being  that  a  rib  had  been  broken,  thereby  causing  his 
death.  To  substantiate  this  charge,  a  skeleton  was  pro- 
duced which  had  been  dug  up  three  months  subsequent 
to  the  decease  of  the  alleged  murdered  man,  which  was 
almost  completely  denuded  of  flesh  ;  the  bones  clean  and 
dry  ;  one  rib  fractured,  with  a  deposit  of  callus  around  the 
fracture.  The  identity  of  these  bones  with  those  of  the 
missing  man  was  attempted  to  be  established  by  the  prose- 
cution, but  unsuccessfully,  in  consequence  of  their  dry  and 
denuded  state  —  a  condition  altogether  incompatible  with  so 
short  a  period  of  time  as  three  months  since  death.  More- 
over, the  amount  of  callus  thrown  out  made  it  evident  that 
more  than  a  week  must  have  elapsed  before  death  took 
place,  which  event  was  alleged  to  have  occurred  immedi- 
ately after  .the  injury. 

Other  notable  instances  might  be  mentioned  of  the  iden- 
tification of  the  skeleton  by  means  of  the  above-mentioned 


96  MEDICAL    JURISPRUDENCE. 

marks,  or  peculiarities,  and  even  where  it  was  possible  to 
determine  the  actual  cause  of  the  violent  death.  In  the 
year  1823,  a  soldier  living  in  the  south  of  France  suddenly 
disappeared  under  suspicious  circumstances.  Two  years, 
however,  elapsed  before  any  investigation  was  instituted  by 
the  proper  authorities.  Some  human  bones  were  then  dis- 
covered in  digging  in  the  garden  of  the  deceased  soldier. 
Of  course,  it  became  necessary  to  identify  these  remains. 
It  was  remembered  that  the  deceased  had  a  singular  per- 
sonal deformity,  in  possessing  a  sixth  finger  on  the  right 
hand,  and  a  sixth  toe  on  the  left  foot.  On  examination,  it 
was  ascertained  that  the  fifth  metacarpal  bone  of  the  right 
hand  was  shorter  and  broader  than  the  corresponding  bone 
of  the  other  hand,  and  further,  that  there  were  two  articu- 
lating surfaces  on  its  digital  end,  indicating  clearly  the  ex- 
istence of  a  supernumerar}'  finger.  In  the  same  way  the 
fifth  metatarsal  bone  of  the  left  foot  showed  two  distinct 
articulating  faces  on  its  digital  extremity,  indicating  the 
existence  of  a  supernumerary  toe.  Besides  this,  the  age, 
sex,  and  stature  of  the  skeleton  corresponded  with  those 
of  the  missing  man.  But  even  further  than  this,  a  close 
inspection  of  the  skull  revealed  the  distinct  marks  of  a  de- 
pressed and  radiated  fracture  of  the  temporal  bone,  which 
showed  no  sign  of  reparation  by  the  formation  of  callus. 
Evidently,  then,  death  had  occurred  very  soon  after  the 
fracture  of  the  skull,  and  in  all  probability  as  the  direct 
result  of  violence.  Upon  this  evidence,  the  suspected  par- 
ties were  tried  and  executed,  having  previously  confessed 
their  crime. 

Sometimes,  on  the  exhumation  of  bones,  the  question 
arises  as  to  how  long  they  have  been  buried.  After  all  the 
soft    parts    have    disappeared,    which    commonly    requires 


IDENTIFICATION    BY    SKELETON.  97 

about  ten  years,  it  is  only  possible  to  give  an  approximate 
estimate.  In  a  dry  soil,  bones  will  resist  decomposition 
for  thirty  or  forty  years  after  burial ;  and  if  preserved  out 
of  the  ground,  as  in  the  crypts  of  old  churches,  they  may 
last  for  hundreds  of  years.  As  the  process  of  decay  pro- 
gresses they  become  lighter  in  weight,  in  consequence  of 
the  loss  of  animal  matter,  and  the  color  externally  grows 
darker.  The  ends  gradually  become  brittle  and  crumble 
away,  and  finally  the  shaft  of  the  bone  undergoes  a  similar 
disintegration,  the  mineral  matter  alone  remaining  unal- 
tered. Devergie  states  that  the  bones  of  King  Dagobert 
were  found  in  a  state  of  tolerable  preservation,  enclosed  in 
a  leaden  coffin  and  sarcophagus,  at  St.  Denis,  after  the 
lapse  of  twelve  hundred  years  ;  and  Dr.  Taylor  mentions 
that  the  skeleton  of  William  Rufus  was  found  in  a  stone 
coffin  at  Winchester  nearly  perfect,  after  seven  hundred 
and  eighty  years'  burial.  The  bones  of  Abelard  and 
Heloise  were  so  well  preserved  that  after  a  lapse  of  five 
hundred  years  the  female  skeleton  could  readily  be  distin- 
guished from  the  male. 

Even  if  the  bones  have  undergone  calcination,  as  when  a 
body  has  been  burned  with  a  view  of  destroying  its  identity, 
especially  in  cases  of  infanticide,  it  may  still  be  possible  to 
determine  whether  the  remains  are  human,  provided  the 
bones  preserve  their  proper  form  and  have  not  been  re- 
duced to  powder. 

Other  means  of  personal  identification  are  afforded  by  a 
microscopic  examination  of  the  hair  and  the  fibers  of  various 
sorts  of  fabrics,  such  as  cotton,  wool,  and  silk.  Human 
hair  discovered  on  a  weapon,  along  with  blood  stains, 
affords  strong  presumptive  evidence  of  murder  or  violence. 
So,  also,  fibers  of  cotton,  or  of  other  material,  found  on 


98  MEDICAL   JURISPRUDENCE. 

weapons  supposed  to  have  caused  death,  or  else  on  the 
person  of  the  accused,  suggest  a  strong  suspicion,  if  these 
fibers  correspond  to  the  clothes  of  the  deceased.  Thus  a 
case  is  mentioned  by  Taylor,  where  the  discovery  of  some 
cotton  fibers,  accompanied  by  a  blood  stain,  upon  the  edge 
of  a  razor,  found  near  a  woman,  whose  throat  had  been  cut 
while  in  bed,  led  to  the  subsequent  detection  of  the  mur- 
derer. In  the  same  manner,  the  discovery  of  a  few  hairs 
upon  the  handle  of  a  knife,  on  which  also  were  marks  of 
blood,  enabled  a  London  microscopist  to  declare  that  these 
hapfs  were  squirrel  hairs  ;  which  circumstance  further  led  to 
the  identification  of  the  murderess  of  a  child,  whose  throat 
had  been  cut  with  a  knife,  which,  in  the  death  wound,  had 
passed  through  a  victorine  made  of  squirrel  fur  worn  around 
the  child's  neck. 

In  case  of  rape,  the  examination  of  the  hair  about  the 
female  genitals  will  be  likely  to  show  the  presence  of  seminal 
spots  and  of  spermatozoids. 

In  all  cases,  except  when  hairs  are  to  be  examined  for 
spermatozoids,  they  should  be  washed  in  warm  water  and 
then  thoroughly  dried,  afterward  steeped  in  turpentine  and 
finally  mounted  in  Canada  balsam.  They  should  then  be 
examined  with  a  magnifying  power  of  about  200  diameters. 
To  examine  hairs  for  spermatozoids,  moisten  first  of  all  with 
a  drop  of  ammonium  hydroxid  solution,  and  examine  under 
a  microscope  after  the  liquid  has  evaporated. 

For  the  identification  of  hairs,  human  or  other,  it  is  de- 
sirable to  have  at  hand  specimens  of  various  kinds  of  these, 
properly  mounted  for  comparison.  Hairs  resist  putrefac- 
tion for  a  long  time.  It  should  also  be  remembered  that 
hair  is  affected  differently  by  different  reagents.  Strong 
alkalies  dissolve  it ;  acids  roughen  it ;  alcohol  causes  it  to 
look  clearer ;  chlorin  water  bleaches  and  rots  it. 


IDENTIFICATION    OF    HAIRS.  99 

The  size  of  hairs  from  different  parts  of  the  human  body, 
as  well  as  from  different  individuals,  varies  considerably  ; 
thus,  the  hairs  from  the  head  are  finer  than  the  eyelashes, 
but  coarser  than  the  hairs  from  the  arm.  There  is  also 
considerable  difference  in  the  size  of  the  hairs  of  the  various 
lower  animals. 

The  main  medico-legal  questions  connected  with  the 
identification  of  hairs  are  :  (i)  Is  the  hair  human,  and  from 
what  part  of  the  body  ?  (2)  Does  it  correspond  with  the 
hair  of  the  murderer  or  of  the  victim  ?  (3)  Has  its  color 
been  naturally  or  artificially  changed  ?  It  should  be  re- 
membered that  gray  hair  is  not  infrequently  found  on  com- 
paratively young  persons,  and  that  undoubted  instances 
have  occurred  of  the  sudden  bleaching  of  the  hair  through 
fright  or  grief  As  regards  the  artificial  coloring  of  the 
hair,  it  is  well  known  that  this  is  one  of  the  means  of  dis- 
guise most  commonly  adopted  by  criminals  in  order  to 
elude  detection. 

Many  common  hair  dyes  for  coloring  light  or  red  hair 
black  or  brown,  are  composed  of  the  salts  of  lead,  silver,  or 
bismuth,  but  organic  colors  are  also  used.  Colors  may 
often  be  detected  by  soaking  the  hair  in  nitric  acid,  which 
dissolves  out  the  mineral,  which  may  then  be  identified  by 
the  appropriate  tests.  It  is  more  difficult  to  bleach  the  hair 
than  to  darken  it.  This  is  usually  effected  by  washing  it  in 
an  alkaline  solution  to  remove  grease,  and  then  soaking  it 
in  chlorin  water  or  hydrogen  dioxid  solution,  which  will 
lighten  the  tint  in  a  few  hours.  Chlorin  water  renders  the 
hair  very  brittle  and  imparts  an  odor  to  it. 

In  all  artificially  colored  hair,  the  fraud  can  be  detected  by 
closely  watching  the  new  growth,  which  will  be  of  a  different 
color  from  the  other  portions ;  and  also  by  chemical  tests. 


lOO  MEDICAL   JURISPRUDENCE. 

The  fibers  of  cotton,  linen,  wool,  and  silk  all  present  well- 
marked  differences  when  viewed  under  the  microscope. 
The  cotton  fiber  is  in  the  form  of  a  flattened  band,  with 
thickened  borders,  and  is  spiral  or  twisted  upon  itself. 
Linen  consists  of  round  fibers,  having  a  firm  consistency, 
with  jointed  transverse  markings  at  unequal  distances,  some- 
what resembling  those  on  the  India  cane  and  tapering  to 
a  point.  Silk  fiber  has  the  appearance  of  straight,  well- 
defined  cylinders,  free  from  all  markings  and  refracting  light 
powerfully.  Wool  fiber  is  irregular,  wavy,  and  of  unequal 
thickness.  The  fibers  of  hemp  resemble  those  of  flax 
(linen),  but  are  coarse  ;  and  when  boiled  in  nitric  acid  they 
exhibit  no  spiral  streaks,  but  swell  and  become  brittle. 

The  identification  of  blood  stains  and  seminal  spots  will 
be  treated  of  later. 


CHAPTER   VI. 

CAUSES    PRODUCING  VIOLENT    DEATH. 

The  third  important  question  requiring  decision  in  every 
case  of  violent  death  is  the  cause  of  the  death.  These 
causes  are  numerous  and  diversified,  but  may  be  considered 
under  the  following  heads  :  — 

( 


v!i 


Wounds. 

Burns  and  Scalds. 

Suffocation. 

Strangulation. 

Hanging. 


Drowning. 
Electricity. 
Heat  and  Cold. 
Starvation. 
Poisoning. 


VIOLENT   DEATH   FROM   WOUNDS. 

A  wound  is  a  solution  of  continuity,  in  any  tissue,  pro- 
duced by  violence.     It  may  be  subcutaneous  —  that  is,  be- 
neath the  skin  —  or  it  may  be  open  ;    further,  wounds  may 
be  superficial   or  deep  ;    they  may  be  incised,  punctured, 
{  contused,   lacerated,   poisoned,    gunshot,   etc.      Penetrating 
io  ]  wounds    enter    cavities,  but    do    not    emerge  ;    perforating 
^  wounds  both  enter  and  emerge  from  the  cavity. 

A  distinction  is  sometimes  made  between  mortal  and 
non-mortal  wounds,  or  between  wounds  dangerous  and  not 
dangerous  to  life,  and  the  medical  witness  is  asked  to  give 
an  opinion  on  this  subject.  He  should  be  guarded  in  his 
''  answer,  since  it  is  well  known  that  many  wounds  at  first 
considered  as  comparatively  trivial,  may  assume  a  danger- 
ous and  even   fatal  character.     Of  course,  in  many  cases 

lOI 


I02  MEDICAL    JURISPRUDENCE. 

there  would  be  no  difficulty  in  pronouncing  upon  the  dan- 
gerous or  mortal  character  of  a  wound ;  for  instance, 
wounds  of  the  heart  or  the  great  vessels  or  internal  viscera, 
or  compound  fracture  of  the  skull.  The  danger  of  a 
wound  depends  upon  many  circumstances,  all  of  which 
should  be  considered,  such  as :  position  ;  relation  to  the 
great  vessels  and  nerves  ;  weapon  by  which  it  was  inflicted  ; 
amount  of  hemorrhage ;  age ;  constitution  and  general 
health  of  the  subject ;  circumstances  (favorable  or  unfavor- 
able) for  treatment.  Medical  testimony  is  usually  required 
only  in  case  of  a  fatal  termination,  except  in  the  case  of 
assault,  when  the  character  of  the  injury  (whether  dan- 
gerous or  trivial)  might  decide  as  to  the  propriety  of  ac- 
cepting bail  for  the  prisoner. 

In  case  of  death  from  a  wound,  the  medical  examiner 
should  never  theorize  as  to  the  manner  of  its  causing  the 
death  ;  and  he  should  give  his  opinion  only  after  a  very 
careful  post-mortem  examination  of  the  body.  Moreover, 
as  before  mentioned,  the  examination  should  not  be  con- 
fined simply  to  the  wounded  portion  of  the  body,  but  all 
the  cavities  and  organs  should  be  inspected,  since  it  may 
be  affirmed  that  a  natural  cause  of  death  might  have  existed 
in  that  very  part  which  was  neglected  by  the  examiner. 
Such  neglect  has  often  occasioned  a  doubt  in  the  minds  of 
the  jury  as  to  the  real  cause  of  death.  It  may  be  necessary 
to  examine  the  stomach  for  poison,  as  shown  by  the  oft- 
quoted  instance  recorded  by  Wildberg,  of  the  girl  who  was 
beaten  by  her  father  for  stealing,  and  who  died  shortly 
afterward,  apparently  from  the  effects  of  the  blows,  but 
in  whose  stomach  a  considerable  quantity  of  arsenic  was 
found.  She  had  swallowed  the  poison  soon  after  commit- 
ting the  theft,  fearing  her  father's  anger.     The  accused  was 


WOUNDS    A    CAUSE    OF    DEATH.  IO3 

discharged.  In  a  similar  manner  it  sometimes  happens 
that  a  person,  after  taking  poison  with  suicidal  intent  or 
after  stabbing  himself  through  the  heart  (death  not  being 
instantaneous),  may  destroy  himself  by  another  means,  as 
by  a  gunshot  wound,  by  drowning,  or  by  throwing  himself 
from  a  window  or  a  precipice. 

The  examination  of  the  wound  includes  the  observation 
of  its  situation,  extent,  and  direction  ;  the  presence  or  ab- 
sence of  effused  blood,  whether  liquid  or  coagulated,  and 
the  presence  of  ecchymoses  ;  the  condition  of  the  edges 
of  the  wound,  whether  everted  or  not ;  whether  adhesion 
has  commenced  ;  the  presence  of  granulation,  inflammation, 
suppuration,  or  gangrene  ;  whether  it  was  inflicted  before 
or  after  death  ;  whether  there  is  loss  of  substance,  or  hernia 
of  the  viscera.  The  clothes  of  the  deceased  should  be 
inspected  to  ascertain  if  the  rents  or  perforations  in  them 
correspond  with  the  wounds  of  the  body.  If  the  weapon, 
say  a  knife,  with  which  the  wound  is  alleged  to  have  been 
made,  is  at  hand,  it  should  not  be  used  in  the  examination 
or  comparison  with  the  wound.  Another  instrument  ex- 
actly like  the  one  in  question,  or  a  piece  of  wood  shaped 
like  the  supposed  weapon,  may  be  substituted.  The  fol- 
lowing recent  case  is  in  point :  An  old  man  was  found 
dead,  with  his  throat  cut,  and  the  butcher-knife  with  w^hich 
the  wound  was  alleged  to  have  been  produced  was  fitted 
into  the  wound  in  the  neck.  Later  it  was  found  that  this 
particular  knife  had  been  used  a  short  time  previously  by 
the  defendant  in  killing  poultry,  and  he  maintained  that 
the  blood  found  on  it  at  the  inquest  was  that  of  a  chicken 
or  turkey.  The  microscope  afterward  showed  the  presence 
of  both  mammalian  and  oviparous  blood ;  but  the  knife 
having  been  placed  in  the  wound  post-mortem,  rendered 


I04  *rEDICAL  JURISPRUDENCE. 

the  evidence  adduced   by  the   microscopic   examination  of 
no  value. 

In  cases  of  severe  injur}'  it  sometimes  happens  that  death 
results  from  internal  lesions,  A\ith  few  or  no  external  marks. 
According  to  Casper,  this  is  of  frequent  occurrence  in 
severe  internal  lacerations  occasioned  by  violence.  He 
cites  an  illustrative  case  :  A  Avagoner,  in  guiding  a  team 
drawing  a  loaded  wagon  down  a  hill,  was  accidentally 
crushed  against  a  tree  on  the  road.  He  w^as  found  dead 
the  next  morning.  The  onl}-  external  injuries  Avere  a 
slight  abrasion  upon  the  left  arm,  and  one  upon  the  right 
temple.  On  opening  the  bod}-,  however,  the  most  striking 
CAidences  of  A'iolence  were  discovered.  From  the  spinal 
canal  about  a  quart  of  blood  escaped.  The  spinous  proc- 
esses of  the  first  thoracic  vertebrae  were  broken  off.  The 
left  pleural  ca\dt}^  contained  about  thirt}'  ounces  of  fluid 
blood.  The  pericardium  was  torn  completely  across  ;  and 
the  heart,  severed  from  its  large  vessels,  la}*  almost  entirely 
loose  in  the  ca\dty  of  the  thorax.  The  open  ends  of  the 
aorta  and  pulmonar}'-  artery  w^ere  distinctl}-  visible.  The 
left  lung  was  entirely  torn  through  its  middle  portion  ;  and 
in  the  right  lobe  of  the  liver  was  a  laceration  two  inches 
long  and  half  an  inch  deep. 

The  distinction  between  wounds  made  before  and  after 
death  must  be  carefully  noted.  Wounds  inflicted  before 
death  ma}^be  recognized  by  the  folloAving  signs  :  (i)  Incised 
wounds  exhibit  everted  edges,  arising  from  the  elasticit}'  of 
the  skin  and  subjacent  muscles,  witli  considerable  hemor- 
hage,  usually  of  an  arterial  character ;  spots  of  arterial 
blood  Avhich  have  spouted  on  to  neighboring  surfaces  are 
of  a  peculiar  comet-like  shape.      Coagula  are  more  or  less 


WOUNDS   BEFORE   AND   AFTER    DEATH.  IO5 

abundant  in  the  wound,  and  around  it.  The  surrounding 
tissues  are  more  or  less  infiltrated  with  blood.  If  some 
days  have  elapsed  before  death,  evidences  of  vital  reaction 
will  be  shown,  such  as  partial  healing,  granulation,  suppura- 
tion, or  sloughing.  If  the  wound  was  made  immediately 
after  death  —  within  a  few  minutes  —  there  may  be  some 
retraction  of  the  skin  and  some  slight  bleeding,  with  few 
or  no  coagula,  which  are  of  loose  texture.  There  is  little 
or  no  staining  of  the  surrounding  tissues,  and  never  any 
attempt  at  repair.  If  the  wound  be  made  ten  or  twelve 
hours  after  death,  there  will  be  no  eversion  of  its  edges,  no 
hemorrhage,  except  of  a  slight  venous  character,  and  no 
surrounding  infiltration.  The  experiments  of  Taylor  and 
Aston  Key  upon  amputated  limbs  confirm  the  above  de- 
scription. The  amount  of  hemorrhage  accompanying  an 
incised  wound  affords  a  pretty  good  criterion  as  to  whether 
it  was  inflicted  before  or  after  death.  Comparatively  little 
bleeding,  chiefly  venous,  accompanies  wounds  made  after 
death  ;  while  in  the  living,  the  hemorrhage  is  chiefly  arterial. 
In  a  case  of  murder  reported  by  Casper,  as  also  in  the  case 
of  Greenacre,  in  England  in  1837,  in  which  the  head  of  the 
victim  was  severed  from  the  body,  the  fact  that  the  head 
was  completely  drained  of  blood  led  to  the  conclusion  that 
the  decapitation  had  been  done  during  life,  and  that  there 
must  then  have  been  a  copious  hemmorhage  to  account  for 
the  absence  of  the  blood  after  death. 

(2)  In  lacerated  and  contused  wounds  the  distinction  is 
not  so  obvious  as  in  incised  wounds.  Lacerations  are  not 
always  accompanied  by  bleeding,  but  there  will  always  be 
more  or  less  coagula  present ;  and  if  the  person  survives  a 
few  days,  there  will  be  evidences  of  vital  reaction,  such 
as   suppuration   and    granulation,    sloughing   or   gangrene, 

9 


I06  MEDICAL   JURISPRUDENCE. 

all  of  which  are  absent  in  such  wounds  inflicted  after 
death. 

Contused  wounds  made  during  life  are  chiefly  distin- 
guished by  the  amount  of  effused  blood  in  the  cellular 
tissue  under  the  skin  (ecchymosis).  This  arises  from  the 
rupture  of  small  vessels,  and  is  manifested  by  the  well- 
known  "  black-and-blue  "  discoloration  produced.  If  the 
effusion  of  blood  is  rapid,  the  spot  is  dark  red  at  first ; 
if  slower,  the  discoloration  is  deep  blue  or  violet.  In  some 
cases  of  even  violent  contusion,  there  may  be  no  appear- 
ance of  external  ecchymosis.  Again,  it  is  not  always  mani- 
fested immediately  over  the  seat  of  the  contusion,  but  at  a 
little  distance  from  it,  especially  if  the  surrounding  tissue 
is  loose.  Familiar  illustrations  of  this  are  afforded  in  the 
case  of  a  blow  over  the  eye,  producing  an  ecchymosis  of 
the  lower  lid  ;  and  of  a  blow  over  the  lower  portion  of  the 
abdomen  being  attended  with  ecchymosis  of  the  scrotum. 
The  presence  of  ecchymoses,  then,  in  cases  of  contused 
wounds,  may  be  regarded  as  pretty  good  evidence  of  the 
ante-mortem  character  of  the  injury,  while  its  absence  is 
not  necessarily  an  indication  that  the  wound  is  post- 
mortem. The  experiments  of  Christison  upon  the  dead 
body  go  to  show  that  if  the  contusion  be  made  very  soon 
after  death,  and  while  the  body  is  still  warm,  the  resulting 
appearances  strongly  resemble  those  produced  by  ante- 
mortem  contusion  —  so  much  so  as  to  be  easily  mistaken  for 
the  latter ;  with  this  difference,  however,  that  the  effusion 
is  usually  immediately  beneath  the  skin,  and  not  in  the 
areolar  tissue  ;  also  that  there  is  an  absence  of  coagula 
and  of  swelling. 

Ecchymosis  is  usually  superficial,  and  may  appear  very 
shortly  after  the. injury  ;  or  it  may  be  deep-seated  and  not 


ECCHYMOSIS.  107 

visible  at  all.  In  some  instances  it  is  not  manifested  until 
after  death,  as  in  the  case  of  a  man  who  died  from  rupture 
of  the  bladder  resulting  from  the  kick  of  a  horse,  thirty- 
five  hours  after  the  injury  ;  no  discoloration  of  the  abdomen 
was  obsei'ved  until  after  his  death.  Neither  can  the  quan- 
tity of  blood  effused  nor  the  extent  of  the  injury  be  always 
estimated  by  the  amount  of  the  discoloration.  This  is  well 
illustrated  in  Casper's  case  of  the  wagoner  who  was  crushed 
to  death. 

Another  important  fact  relative  to  ecchymoses  is  the 
change  of  color  which  accompanies  them,  since  this  may 
serve  to  indicate  the  probable  date  of  the  contusion.  In 
about  twenty-four  hours  the  blue  or  livid  margin  of  the 
bruises  becomes  lighter,  or  of  a  violet  color,  which  gradu- 
ally changes  to  green  and  yellow.  During  these  alterations 
of  color  the  spot  may  become  larger,  but  the  central  por- 
tion remains  always  darker  than  the  margins.  The  color 
is  finally  absorbed  and  entirely  disappears.  In  general, 
the  ecchymosis  shows  itself  within  twelve  hours  after  the 
contusion  ;  the  violet  color  within  three  days  ;  the  green, 
from  the  fifth  to  sixth  day  ;  the  yellow,  from  the  eighth  to 
tenth  day  ;  and,  in  healthy  persons,  the  complete  disappear- 
ance of  the  spot  occurs  from  the  twelfth  to  fourteenth  day. 
The  changes  are  more  rapid  in  the  young  than  in  the  old, 
and  depend  also  on  the  degree  of  the  contusion.  The  above 
changes  of  color  never  appear  in  contusions  on  the  dead, 
which  circumstance  constitutes  another  diagnostic  mark. 

It  is  also  important  not  to  mistake  the  ecchymosis  pro- 
ceedmg  from  natural  causes,  such  as  scurvy,  petechia,  and 
purpura,  for  that  occasioned  by  blows.  The  former  may 
usually  be  distinguished  by  being  confined  to  the  super- 
ficial layers  of  the  skin,  and  by  their  presence  also  on  the 


108  MEDICAL   JURISPRUDENCE. 

internal  mucous  membranes,  together  with  the  absence  of 
swelling  and  the  fluidity  of  the  blood. 

According  to  Devergie,  ecchymoses  are  often  concealed 
on  the  bodies  of  the  drowned  when  first  they  are  removed 
from  the  water,  owing  to  the  sodden  state  of  the  skin  ;  they 
may  become  apparent  only  after  the  body  has  been  exposed 
for  some  days  and  the  water  has  evaporated. 

(3)  In  punctured  and  penetrating  wounds,  the  diagnosis 
between  those  inflicted  before  and  those  produced  after 
death  is  usually  not  difficult.  The  former  are  attended  with 
hemorrhage,  and  often  exhibit  signs  of  vital  and  reparative 
reaction,  such  as  inflammation  and  suppuration,  or  gangrene. 
The  latter  are  destitute  of  all  these.  For  example,  a  stab 
made  into  the  left  ventricle  of  the  heart  after  death  is  fol- 
lowed by  no  hemorrhage. 

Where  inspection  does  not  satisfactorily  prove  the  ante- 
mortem  characteristics  of  a  wound,  the  microscope,  in  the 
absence  of  advanced  decomposition,  will  be  found  invalu- 
able. Suitably  made  sections  will  show  the  presence  of  the 
processes  of  repair  and  the  dissolution  of  blood  thrown  out 
during  the  injury.  In  the  case  of  the  Commonwealth  vs. 
Schmidt,  the  question  of  homicide  or  suicide  turned  upon 
the  age  of  certain  bruises  upon  the  body  of  the  deceased. 
Microscopic  examination  showed  the  subcutaneous  tissue 
to  be  far  advanced  in  the  process  of  repair,  and  positively 
excluded  their  having  been  produced  a  few  hours  before,  or 
immediately  preceding  death. 

As  regards  the  particular  weapon  that  may  have  caused 
the  wound,  it  is  not  always  possible  for  a  medical  witness 
to  give  a  decided  opinion ;  but  it  is  desirable,  if  possible, 
to   establish  the   relation  of  the   injury  with   its   supposed 


Punctured  wounds.  109 

cause  ;  thus,  an  incised  wound  would  naturally  h6  feferred 
to  a  cutting  weapon  ;  a  penetrating  wound  to  a  pointed  one, 
a  bullet  or  missile  ;  and  a  contused  wound  to  a  blunt  instru- 
ment ;  but  caution  should  be  observed  in  giving  an  opinion 
on  this  subject,  especially  in  case  of  contused  wounds. 

Incised  wounds  are  characterized  by  the  regularity  and 
evenness  of  the  cut.  This  usually  serves  to  distinguish 
them  from  wounds  made  by  glass  and  crockeiy  ware  or 
nails,  which  are  generally  irregular  and  uneven  ;  but  in 
some  instances  the  cuts  produced  by  broken  glass  or  china 
exactly  resemble  incised  wounds.  In  stabs  the  shape  of 
the  wound  may  often  indicate  the  character  of  the  weapon, 
whether  double-edged  or  not,  but  when  the  weapon  has 
penetrated  obliquely  through  the  tissues,  and  when  these 
have  been  stretched,  the  shape  of  the  wound  will  not  ex- 
hibit this  correspondence.  So,  also,  a  wound  made  in  parts 
where  the  skin  is  wrinkled  may  suggest  the  idea  of  several 
distinct  wounds,  as  in  the  neck.  It  must  not  be  overlooked 
that  superficial  incised  wounds  may  give  rise  to  dangerous 
or  even  fatal  hemorrhage ;  and,  also,  that  it  is  not  always 
possible,  in  such  cases,  to  determine  the  direction  of  the 
incision  —  z.  e.,  whether  made  from  right  to  left  or  the  re- 
verse ;  and  yet,  as  remarked  by  Casper,  this  fact  might  have 
a  most  important  medico-legal  significance  in  determining 
the  question  whether  the  wound,  as  in  cutting  the  throat, 
was  homicidal  or  self-inflicted.  The  attendant  circumstances, 
however,  might  throw  some  light  upon  it,  such  as  the  pres- 
ence of  blood  on  the  right  or  left  hand,  or  cuts  on  certain 
parts  of  the  clothing  of  the  deceased. 

Lacerated  and  contused  wounds  do  not  afford  the  same 
facility  for  identifying  the  weapon  as  incised  wounds.  From 
simply  inspecting  them  it  will  not  generally  be  possible  to 


no  MEDICAL   JURISPRUDENCE, 

indicate  the  precise  weapon  or  cause.  It  may,  Indeed,  be 
possible  to  say  that  it  was  not  produced  by  a  cutting  instru- 
ment ;  but  a  blow  made  by  a  blunt  weapon  upon  the  skull 
or  over  the  zygoma  may  give  rise  to  a  cut  which  strongly 
resembles  an  incised  wound,  though,  as  a  rule,  the  division 
of  the  parts  is  not  as  straight  and  regular  as  in  the  latter 
and  the  angles  of  the  wound  are  less  acute.  Moreover,  in 
the  contused  wounds  there  is  more  or  less  swelling,  and 
extravasation  of  blood  into  the  adjoining  parts  ;  and,  at 
times,  the  existence  of  irregular  fracture  and  internal 
hemorrhage. 

In  the  case  of  a  fatal  contused  wound  of  the  head,  it  has 
been  judicially  decided  that  it  makes  no  difference  as  to  the 
guilt  of  the  accused  whether  he  produced  the  death  of  his 
victim  by  a  direct  blow  upon  the  head,  or  indirectly  by 
causing  him  to  fall  upon  a  stone  or  other  hard  substance 
which  produced  the  fracture  or  contusion. 

As  before  mentioned,  rupture  of  the  internal  organs — the 
liver,  spleen,  heart,  lungs,  and  kidneys — is  a  frequent  result 
of  contusions.  Fracture  of  the  base  of  the  skull  is  some- 
times caused  by  severe  contusion  of  the  head.  Wharton 
and  Stille  allude  to  the  fact  that  spontaneous  wounds  some- 
times occur  in  the  labia  and  vagina  of  pregnant  women, 
which  might  give  rise  to  suspicion  of  assault.  Also,  that 
in  such  women  accidents  of  different  kinds  are  frequently 
attended  with  profuse  hemorrhage  from  the  pudenda. 

It  is  evident  from  what  has  been  said  in  reference  to  the 
difficulty  of  always  connecting  a  contused  wound  with  the 
precise  instrument  that  caused  it,  that  the  witness  should 
avoid  committing  himself  upon  the  question.  In  some 
instances,  however,  the  shape  of  the  contused  wound,  espe- 
cially a  depressed  fracture  of  the  skull,  will  enable  us  to 


LACERATED    AND    CONTUSED    WOUNDS.  1  I  I 

come  to  a  correct  conclusion  on  the  subject.  Some  years 
ago  Dr.  Reese  was  called  upon,  as  an  expert,  to  testify  as 
to  the  probable  cause  of  a  depressed  fracture  of  the  tem- 
poral bone  of  a  man  who  had  been  struck  during  a  general 
fight.  The  question  was  whether  the  injury  had  been 
inflicted  by  the  fist  merely,  as  was  alleged,  or  by  an 
instrument  like  a  loaded  cane  or  billy.  From  the  private 
confession  of  a  comrade  of  the  prisoner  there  was  good 
reason  for  believing  that  the  latter  instrument,  in  the  hands 
of  another  person,  was  the  real  cause  of  his  death.  The 
fractured  bone  was  produced  in  court.  The  depression 
was  well  marked,  a  quarter  of  an  inch  deep,  exactly  cor- 
responding to  the  loaded  end  of  the  billy.  Radiating  fis- 
sures (as  would  probably  have  resulted  from  a  blow  of  the 
fist)  were  not  seen.  The  opinion  of  Dr.  Reese,  founded 
on  the  above  facts,  was  that  the  fatal  blow  had  not  been 
inflicted  by  a  fist,  but  by  a  billy,  but  two  physicians  on 
the  other  side  opposed  this  view.  The  judge  dexterously 
solved  the  mooted  question  by  asserting  that,  in  such  cases, 
one  expert  was  about  as  good  as  another,  and  inasmuch  as 
in  the  present  trial  there  were  two  against  one,  he  would 
decide  in  favor  of  the  majority ;  and  so  he  did,  and  the 
prisoner  (possibly  an  innocent  man)  was  convicted  and  sent 
to  the  penitentiary. 

The  examination  of  the  clothes  of  the  deceased  consti- 
tutes an  important  part  of  the  physician's  duty,  as  this  may 
throw  light  upon  the  mode  in  which  the  wound  had  been 
made,  from  the  character  of  the  cuts  or  stabs  observed 
upon  them.  So,  likewise,  marks  of  blood,  dirt,  grass,  or 
other  substances  on  the  clothing  may  afford  valuable  indi- 
cations in  the  same  direction.  The  same  remark  applies  to 
fragments  of  the  clothing  of  either  the  deceased  or  the  pris- 


112  MEDICAL   JURISPRUDENCE. 

oner  discovered  near  the  dead  body  and  agreeing  with 
the  clothes  worn  at  the  time.  Contused  wounds  by  blud- 
geons may,  however,  occasion  considerable  laceration  of 
the  muscles,  or  even  severe  fractures,  without  tearing  the 
dress. 

Taylor  mentions  an  instructive  case,  showing  the  impor- 
tance of  comparing  the  articles  of  dress  with  the  injuries 
which  may  have  proved  fatal.  A  woman,  aged  sixty,  was 
found  one  morning  dead  in  her  bed.  She  had  been  seen  in 
her  usual  health  on  the  previous  night.  On  inspection, 
there  were  found  two  indentations  in  the  right  parietal 
bone,  and  a  large  clot  of  blood  in  this  situation,  beneath  the 
skin,  together  with  a  fracture  of  the  bone  four  inches  in 
extent.  Beneath  the  bone  on  the  dura  mater  were  found 
nearly  three  ounces  of  clotted  blood.  On  the  evening 
before  her  death  she  had  been  suddenly  knocked  down  on 
the  public  road  by  a  man  accidentally  running  against  her. 
She  fell  heavily  on  the  back  of  her  head,  appeared  stunned, 
was  raised  upon  her  feet,  and,  after  drinking  some  brandy, 
recovered  sufficiently  to  walk  a  mile  and  a  half  and  eat 
supper.  There  was  a  suspicion  of  murder,  in  this  case, 
against  a  fellow-lodger ;  but  when  the  bonnet  worn  by  the 
woman  was  produced  at  the  inquest,  two  indentations  were 
discovered  on  the  back  part  of  it  corresponding  to  those  on 
the  skull  of  the  deceased.  The  indentations  on  the  bonnet, 
moreover,  contained  dust  and  dirt,  thereby  confirming  the 
statement  of  witnesses  who  had  seen  her  fall,  and  rendering 
it  highly  probable  that  this  fall  was  the  real  cause  of  the  fatal 
fracture  and  effusion  of  blood.  It  also  illustrates  the  well- 
known  fact  that  a  person  may  receive  a  fracture  of  the  skull, 
ending  in  effusion,  which  may  not  prove  fatal  for  many 
hours  after  the  accident,  and  which  may  not  have  prevented 


EXAMINATION    OF    THE    CLOTHES.  II 3 

the  individual  from  walking    a  considerable  distance   after 
the  injury. 

Was  the  wound  homicidal,  suicidal,  or  accidental?  This 
important  question  cannot  always  be  settled  by  medical 
testimony  alone,  though  there  are  many  points  in  which  it 
is  of  the  greatest  aid.     These  are  as  follows  : 

1.  The  Sittiatiou  of  the  IVoimd. — Suicidal  wounds  are 
usually  inflicted  upon  the  most  accessible  parts  of  the  body, 
such  as  the  head,  neck,  breast,  and  abdomen.  If  by  fire- 
arms, the  part  usually  selected  is  the  head  (mouth,  forehead, 
or  temple)  or  over  the  heart ;  if  by  a  cutting  instrument, 
the  throat  or  heart.  The  discovery,  therefore,  of  wounds 
on  a  part  of  the  body  difficult  to  reach  by  the  individual 
himself,  as  the  back,  would  certainly  not  be  suggestive  of 
suicide ;  but  an  exception  must  be  made  here  as  regards 
the  insane,  who  are  well  known  to  destroy  themselves  by 
self-inflicted  wounds  of  the  most  extraordinary  character 
on  the  back  of  the  head  and  neck,  by  striking  the  head 
against  some  solid  substance,  or  by  precipitating  themselves 
from  a  height.  An  insane  person  (as  also  the  sane)  has 
been  known  to  shoot  himself  with  a  pistol  fired  from  behind 
the  ear.  The  situation  of  the  wound  is,  therefore,  only 
suggestive  of  its  origin,  since  it  is  quite  possible  that  an 
assassin  might  inflict  a  death  wound  upon  his  victim  in  such 
a  situation  designedly,  in  order  to  deceive,  and  thus  elude 
the  suspicion  of  homicide.  Accidental  wounds  are  usually 
met  with  on  exposed  parts  of  the  body. 

2.  Nature  and  Extent  of  the  Wound. — Suicide  is  rarely 
inflicted  by  contused  wounds,  but  usually  by  incised  or 
penetrating  ones.  Exceptions  occur,  as  when  a  person 
throws  himself  out  of  a  window  or  from  a  height ;  and, 
in  some  remarkable  instances  of  self-destruction  in  the  in- 


114  MEDICAL    JURISPRUDENCE. 

sane,  by  butting  the  head  against  a  wall,  and  subsequently 
chopping  it  with  a  hatchet.  In  the  case  of  the  insane, 
there  is  no  accounting  for  the  variety  in  the  nature  and 
extent  of  the  wounds  inflicted  for  the  purpose  of  self- 
destruction.  This  fact  ought  to  be  remembered,  since,  if 
the  bodies  of  such  persons  should  afterward  be  discovered, 
and  nothing  be  known  of  their  previous  histories,  serious 
errors  in  relation  to  the  real  origin  of  the  wounds  might 
result. 

Incised  ivoiinds  of  the  throat  are  often  regarded  as  indi- 
cating suicide ;  but  it  is  well  known  that  murderers  fre- 
quently destroy  their  victims  by  cutting  their  throats.  As 
to  the  extent  of  the  wound,  it  is  commonly  supposed  that  a 
suicidal  incision  of  the  throat  does  not  reach  as  deeply  as 
a  homicidal  one  of  the  same  character ;  but  instances  are 
not  wanting  where  a  determined  suicide  has  severed  the 
throat  down  to  the  vertebrae.  Again,  irregularity  in  the 
cut  of  the  throat  has  been  deemed  by  some  as  indicating 
homicide  rather  than  suicide,  under  the  idea  of  resistance 
on  the  part  of  the  victim  ;  but  it  is  evident  that  the  irregu- 
larity might  have  resulted  equally  from  nervousness  or  in- 
decision in  inflicting  the  wound  on  the  part  of  the  deceased. 

The  nature  and  extent  of  the  wound  or  injury  may  serve 
to  distinguish  accident  from  homicide.  Thus,  if  numerous 
wounds  or  bruises  are  discovered  in  opposite  sides  of  a 
dead  body,  the  presumption  would  be  in  favor  of  homicide  ; 
and  when  the  accused  attempts  to  ascribe  the  death  of  his 
victim  to  a  fall,  the  nature  of  the  wounds  might  be  such  as 
positively  to  contradict  his  assertions. 

3.  Direction  of  the  Wound. —  This  will  often  enable  us  to 
distinguish  between  a  homicidal  and  an  accidental  wound 
rather  than  to  decide  upon  its  suicidal  character.     Thus,  if 


DIRECTION    OF    THE    WOUND.  I  I  5 

death  has  occurred  from  a  stab,  inflicted  downward  from 
the  upper  part  of  the  thorax  and  penetrating  the  heart,  as 
did  happen  in  a  certain  case,  and  it  was  attempted  on  the 
part  of  the  prisoner  to  show  that  the  wound  had  been  acci- 
dentally occasioned  by  the  deceased  falling,  while  drunk, 
downward  upon  the  knife  which  the  prisoner  had  held  in 
his  hand  sloping  upward,  the  downward  direction  of  the 
wound  would  prove  the  falsity  of  the  statement.  Two 
other  cases  may  be  quoted  from  Wharton  and  Stille  of  a 
similar  character.  One  is  that  of  a  man  discovered  dead, 
with  a  deeply-punctured  wound  of  the  neck,  which,  on 
examination,  showed  that  the  weapon  had  been  partially 
turned  and  withdrawn,  and  again  plunged  into  the  neck  in 
a  different  direction,  after  the  manner  of  the  German 
butchers.  This  circumstance  proved  not  only  that  the 
death  was  not  accidental,  nor  probably  suicidal,  but  pointed 
to  a  homicide,  and  also  indicated  the  occupation  of  the 
murderer.  The  other  occurred  in  England,  some  years 
since,  where  a  murder  was  fixed  upon  a  man  from  the  fact 
that  the  wound  in  the  neck  of  the  deceased  had  been  evi- 
dently made  by  a  knife  cutting  from  within  outward,  as  is 
done  in,  slaughtering  sheep. 

In  most  suicidal  wounds  of  the  throat  it  is  found  that 
the  cut  has  been  made  from  left  to  right ;  in  punctured 
wounds  the  direction  is  commonly  from  right  to  left  and 
downward.  In  left-handed  persons  the  direction  would,  of 
course,  be  the  reverse.  These  facts,  however,  can  only 
afford  moderate  presumptive  evidence,  since  it  is  obvious 
that  a  murderer  might  inflict  an  incised  wound  in  the  throat 
of  his  victim  from  behind,  which  would  exactly  resemble 
that  made  by  the  suicide.  In  all  such  doubtful  cases  par- 
ticular attention    should   be    directed   to  the    surrounding 


Il6  MEDICAL  JURISPRUDENCE. 

circumstances,  such  as  the  position  of  the  body  and  the 
weapon,  the  presence  or  absence  of  blood  upon  the  hands 
and  person  of  the  deceased,  etc.  If  the  death  has  been 
very  sudden,  from  hemorrhage  (in  a  case  of  suicide),  the 
weapon  will  most  probably  have  fallen  from  the  hand,  on 
account  of  the  relaxation  of  the  muscles  ;  but  if  it  has  been 
caused  by  a  pistol,  the  weapon  may  be  found  tightly 
grasped  in  the  hand  of  the  deceased.  If  the  throat  has 
been  cut  suicidally,  blood  will  be  found  on  one  or  other  of 
the  hands  ;  but  if  homicidally,  and  no  resistance  has  been 
made,  the  hands  will  probably  be  unstained.  As  regards 
the  position  of  the  body,  if  the  death  be  very  sudden,  from 
loss  of  blood,  the  body  will  be  found  lying  on  the  back ;  if 
less  sudden,  the  face  and  trunk  will  be  turned  toward  the 
ground.  If  the  body  be  found  upon  the  back,  in  death 
from  hemorrhage,  and  the  weapon  at  a  distance  from  it,  the 
act  was,  in  all  probability,  homicidal. 

The  position  of  the  weapon  in  relation  to  the  dead  body, 
although  at  times  strongly  suggestive,  can  never  afford 
absolute  evidence  as  regards  the  question  of  homicide  or 
suicide.  Thus,  Casper  mentions  the  case  of  a  man  who  cut 
his  throat  with  a  razor,  which  was  found  bloody  and  closed, 
two  feet  distant  from  the  body.  Also,  of  another  suicide 
by  a  pistol-shot  in  the  breast,  where  the  pistol  was  found  in 
the  pocket  of  the  deceased,  who  had  afterward  terminated 
his  life  by  drowning  himself. 

From  what  has  been  said  above,  it  is  manifest  that  the 
witness  can  rarely  venture  to  give  a  positive  opinion  as  to 
the  homicidal,  suicidal,  or  accidental  cause  of  death,  apart 
from  a  consideration  of  the  circumstances  accompanying  it. 
These  circumstances  vary  in  every  case,  and  it  requires  the 
utmost  experience  and  tact  on   the   part  of  the   medical 


POSITION    OF    THE    BODY.  I  1 7 

examiner  to  recognize  and  apply  them  in  each  individual 
instance.  Some  of  them  have  already  been  noted  :  they 
include  the  position  of  the  body  and  the  weapon  ;  the  con- 
dition of  the  ground  where  the  wound  was  inflicted  ;  the 
presence  of  footprints  ;  the  condition  of  the  clothing  of  the 
deceased  ;  the  condition  of  the  hands,  whether  showing 
wounds  or  cuts  on  their  palms  (indicating  resistance),  or 
the  hands  holding  portions  of  hair  or  fragments  of  the 
assailant's  clothes ;  the  adherence  of  certain  fibers  to  a 
weapon,  such  as  cotton,  woolen,  linen,  silk,  or  fur ;  marks 
of  blood  upon  clothing  or  furniture  ;  state  of  the  mouth 
and  throat ;  marks  of  blood  or  other  matters  on  the  person 
of  the  assailant ;  rifling  of  the  pockets  and  tearing  of  the 
dress,  etc.  These  cannot  be  further  enlarged  upon  here  ; 
but  their  medico-legal  importance  cannot  be  too  strongly 
enforced. 

When  two  distinct  wounds  are  found  upon  a  dead  body, 
either  of  which  is  sufficient  to  have  caused  death,  the  ques- 
tion may  arise  whether  this  was  a  case  of  suicide  or  homi- 
cide. Is  it  possible  for  a  person  to  inflict  upon  himself, 
consecutively,  two  mortal  wounds,  say  by  shooting  one 
bullet  through  his  brain,  and  another  immediately  afterward 
through  his  heart  ? 

There  can  be,  it  seems,  no  question  about  the  possibility 
of  the  self-infliction  of  two  mortal  wounds,  provided  the 
first  one  was  not  instantaneously  fatal.  It  is  well  known 
that  a  stab  or  bullet  through  the  heart  or  a  pistol-shot 
through  the  brain  is  not  immediately  fatal,  so  that  ample 
time  is  allov/ed  for  the  repetition  of  the  fat^l  act  on  the  part 
of  the  suicide. 

Moreover,  it  is  within  the  bounds  of  possibility  that, 
after  the  first  fatal  shot  from  a  self-cocking  pistol,  a  second 


Il8  MEDICAL    JURISPRUDENCE. 

discharge  from  the  weapon  may  have  been  a  mere  auto- 
matic act — the  victim's  finger  being  at  the  time  on  the 
trigger  and  thus  producing  the  discharge  unconsciously. 
It  might  even  happen  that  this  second  unconscious  and 
chance  shot  might  produce  a  fatal  wound  upon  another 
person,  and  thus  give  rise  to  the  question  of  an  intentional 
or  accidental  homicide. 

Gunshot  wounds  differ  from  other  wounds  chiefly  in 
the  fact  that  the  vitality  of  the  part  struck  is  lost,  and  that 
there  is  a  consequent  slough  or  loss  of  substance.  They 
are  dangerous  to  life  on  account  of  their  involving  vital 
portions  of  the  body,  death  occurring  either  from  hemor- 
rhage or  from  shock  to  the  nervous  system.  The  hem- 
orrhage is  seldom  great,  except  when  large  vessels  are 
wounded.  Often,  from  the  form  of  the  wound,  there  may 
be  but  little  external  bleeding,  while  a  fatal  internal  hemor- 
rhage may  be  going  on.  They  differ  much  in  appearance, 
according  to  the  distance  from  which  the  piece  was  fired,  and 
the  nature  of  the  projectiles.  If  the  explosion  occurs  in  close 
contact  with  the  body,  usually  less  than  nineteen  inches,  the 
wound  is  large  and  circular,  the  skin  denuded,  blackened,  and 
burned  by  the  half- consumed  grains  of  powder.  The  hair 
and  clothes  also  in  the  vicinity  of  the  wound  are  more  or 
less  scorched.  It  may  be  of  vital  importance  to  determine 
the  position  in  which  the  revolver  was  held.  The  follow- 
ing points  will  serve  if  powder-burns  are  present :  The 
wound  of  entrance  is  not  in  the  center  of  the  powder-burn, 
there  being  a  very  much  greater  zone  of  powder-mark  at 
that  area  of  the  burn  which  coincides  with  the  cock  or 
hammer  side  of  the  pistol ;  e.  g.,  if  the  cock  or  hammer  be 
upward,  the  most  of  the  powder-burn  will  be  upward,  and 
whichever  meridian  of  the  powder-burn  shows  the  greater 


GUNSHOT    WOUNDS.  II9 

quantity  of  powder,  marks  the  direction  of  the  cock  or 
hammer.  The  entrance  orifice  of  the  ball  is  livid  and 
depressed,  and  is  larger  than  the  point  of  exit.  When  the 
piece  is  fired  from  a  distance,  the  blackened  and  burned 
appearance  of  the  skin  is  not  seen,  but  only  the  mark  of 
the  entrance  of  the  missile,  and  sometimes  that  of  the  exit. 
The  aperture  of  entrance  of  the  ball  when  fired  from  a  dis- 
tance is,  according  to  most  authorities,  always  smaller  than 
that  of  exit.  Nealton  says  that  when  the  wound  is  recent, 
the  entrance  orifice  is  depressed  and  contused,  while  the 
exit  aperture  is  lacerated  and  everted.  In  the  former,  there 
is  an  actual  loss  of  substance  ;  in  the  latter,  there  is  merely 
a  solution  of  continuity.  After  some  days,  however,  the 
contused  margins  of  the  entrance  wound  slough  away, 
thereby  enlarging  the  orifice,  while  those  of  the  exit  par- 
tially adhere,  causing  the  latter  wound  to  appear  smaller 
than  the  former.  Casper  declares  that  the  entrance  aperture 
is  always  the  larger.  Very  possibly  this  discrepancy  of 
views  may  arise  from  not  distinguishing  between  the  early 
and  the  later  stages  of  the  two  orifices.  If  the  ball  enters 
a  very  fat  portion  of  the  body,  this  often  protrudes  between 
the  edges  of  the  wound  and  completely  changes  its  appear- 
ance. Again,  the  character  of  the  entrance  will  depend 
very  much  upon  the  nature  of  the  projectile  and  its  veloc- 
ity, as  well  as  the  distance  from  which  it  was  fired.  If  the 
ball  is  conoidal,  and  traveling  with  great  speed,  the  wound 
is  Hnear  and  resembles  a  puncture  producing  little  external 
harm,  but  causing  very  considerable  external  injury.  A 
rifle-ball  makes  a  large  and  ragged  wound,  caused  by  the 
spiral  direction  given  to  the  missile.  It  is  evident  that 
several  wounds  may  be  made  by  a  single  ball,  as  this  may 
chance  to  traverse  different  parts  of  the  body  and  limbs.    It 


I20  MEDICAL    JURISPRUDENCE. 

may  also  happen  that  the  piece  may  have  been  loaded  with 
two  or  more  balls,  which  may  account  lor  the  number  of 
the  wounds. 

The  deflection  of  a  ball  from  its  straight  or  direct  course 
after  entering  the  body  is  easily  produced  by  its  striking 
obliquely  against  any  resisting  surface,  such  as  a  bone, 
tendon,  aponeurosis,  or  even  muscle.  In  this  way  it  often 
happens  that  a  ball,  striking  the  chest  or  abdomen,  may  be 
caused  to  pass  almost  entirely  around  the  body,  and  after- 
ward be  extracted  close  by  the  extrance  point.  Wharton 
and  Stille  relate  the  case  of  a  wound  by  a  ball  striking  on 
the  larynx  obliquely,  and  passing  around  the  neck  so  as  to 
lodge  on  the  opposite  side  of  the  thyroid  cartilage.  It  was 
thence  removed  by  simply  cutting  through  the  skin.  It  is 
not  uncommon  for  a  ball  to  travel  half  way  around  the 
chest  or  abdomen  and  lodge  in  the  back,  giving  the  appear- 
ance of  having  passed  directly  through  the  lungs  or  intes- 
tines. 

If  the  wound  be  caused  by  a  load  of  shot,  its  appearance 
will  depend  chiefly  on  the  distance  from  which  it  was  dis- 
charged. If  fired  very  near  the  body,  so  as  to  enter  it  as  a 
single  charge  before  separating,  it  will  produce  a  single 
large  and  ragged  wound,  much  contused  and  blackened  by 
the  powder ;  and  as  the  shot  diverge  after  entering  the 
body  there  will  be  considerable  laceration  of  the  parts 
beneath.  For  the  opening  to  be  single,  the  experiments  of 
Dr.  Lachese,  of  Antwerp,  indicate  that  the  charge  should 
not  be  fired  at  a  greater  distance  than  ten  to  twelve  inches, 
although  this  is  undoubtedly  influenced  as  much  by  the 
construction  of  the  barrel  and  the  charge  as  by  distance  up 
to  twenty  or  thirty  inches.  When  the  distance  is  so  ex- 
tended as  to  allow  the  scattering  of  the  shot,  each  grain 


GUNSHOT    WOUNDS.  121 

will  make  its  own  individual  wound.  It  is  quite  possible 
for  a  single  shot  to  cause  a  mortal  wound,  as  when  it  hap- 
pens to  strike  the  heart  or  aorta. 

The  newly-invented  forms  of  small  arms,  most  of  which 
throw  bullets  at  very  high  velocity  and  are  efficient  at  long 
range,  produce  wounds  that  are  somewhat  different  from 
those  made  by  the  older  weapons.  These  weapons  often 
make  cleaner  cuts  than  the  older  forms.  The  fatality  is 
said  to  be  less  with  the  recent  weapons,  but  this  is  evidently 
influenced  by  the  modern  methods  of  treatment. 

Wounds  made  by  the  wadding  and  gunpowder  alone  may 
prove  serious  or  even  fatal.  A  pistol  thus  loaded,  fired  at 
twelve  inches,  tore  the  clothes  and  abraded  the  skin  without 
penetrating  it ;  at  half  this  distance  the  wadding  penetrated 
to  the  depth  of  half  an  inch  ;  at  two  inches  it  entered  to 
the  depth  of  two  inches,  causing  a  ragged  and  blackened 
wound  ;  and  at  one  and  a  half  inches  the  wadding  entered 
the  thorax  between  the  ribs,  and  in  one  experiment  carried 
away  a  portion  of  the  rib.  Taylor  mentions  an  instance  of 
a  man  sitting  in  the  gallery  of  a  theater,  who  had  part  of  his 
hand  completely  blown  away  by  a  piece  of  greased  news- 
paper, tightly  rammed,  discharged  from  a  small  cannon  on 
the  stage  of  the  theater. 

Even  gunpowder  alone  is  capable  of  producing  very 
serious  wounds,  if  fired  close  to  an  exposed  part  of  the 
body.  The  wound  will  present  a  lacerated  appearance,  and 
be  blackened  and  burned  by  the  partially  consumed  powder. 
If  the  grain  of  powder  be  coarse,  the  wound  may  have  the 
appearance  of  having  been  caused  by  very  small  shot. 

The  question  of  the  homicidal,  suicidal,  or  accidental 
character  of  gunshot  wounds  must  generally  be  settled  by 


122  MEDICAL   JURISPRUDENCE. 

the  appearance  of  the  wounds,  and  also  by  the  particular 
circumstances.  Thus,  if  it  be  on  the  forehead  or  temple, 
behind  the  ear,  in  the  mouth,  or  over  the  heart,  and  if  it 
be  blackened  or  lacerated  (indicating  the  close  proximity 
of  the  weapon),  it  may  be  regarded  as  almost  certainly  a 
suicidal  act.  If,  on  the  contrary,  the  wound  be  on  the  back 
or  side  of  the  head  (except  in  the  case  of  the  insane),  or  of 
the  body,  without  the  blackened  and  lacerated  appearance 
above  alluded  to,  it  may  be  considered  as  the  act  of  a 
homicide.  Accidental  gunshot  wounds  bear  the  marks  of 
near  wounds,  as  they  are  mostly  the  result  of  the  accidental 
discharge  of  the  piece,  either  in  the  hands  of  the  deceased 
at  the  time,  or  else  in  close  proximity  to  his  person.  The 
possibility  of  a  bullet  glancing  from  a  hard  surface,  and 
thus  entering  a  point  at  which  the  weapon  was  not  aimed, 
must  not  be  overlooked. 

Out  of  368  cases  of  suicide  by  firearms,  in  France,  297 
were  from  wounds  in  the  head ;  of  these,  234  were  fired 
into  the  mouth  ;  only  7 1  were  from  wounds  inflicted  on  the 
chest  or  abdomen. 

In  a  medico-legal  case  it  may  become  important  to  ascer- 
tain the  real  cause  of  death  occasioned  by  a  wound  —  whether 
immediate,  or  from  hemorrhage  or  shock,  or  remote,  result- 
ing from  subsequent  complications.  In  a  trial,  this  question 
might  have  an  important  bearing,  since,  if  the  cause  of  the 
death  could  be  shown  to  have  been  remote,  this  might  in- 
volve certain  contingencies,  for  which  the  prisoner  might  not 
be  responsible. 

When  the  death  is  directly  traceable  to  hemorrhage,  its 
rapidity  depends  upon  the  amount  and  suddenness  of  the 
bleeding ;  and  this  again  is  dependent  on  the  size  and 
nature  of  the  vessel  wounded.     Exhaustion  follows  much 


CAUSES    OF    DEATH    FROM    WOUNDS.  1 23 

more  rapidly  from  a  sudden  hemorrhage  than  from  a  more 
copious  flow  of  blood,  if  gradually  lost.  Again,  arterial 
hemorrhage  is  more  rapidly  fatal  than  venous.  It  should 
also  be  remembered  that  some  persons  have  a  constitutional 
tendency  to  bleed  very  easily  from  the  slightest  superficial 
wound.  Such  a  tendency,  termed  a  hemorrhagic  diathesis, 
is  sometimes  hereditary,  and  exposes  the  individual  to  great 
danger,  in  case  of  being  wounded.  This  circumstance 
might  also  have  weight  in  the  trial.  Age  and  disease  also 
increase  the  danger  of  death  by  hemorrhagic  from  wounds. 

Internal  hemorrhage,  as  the  result  of  a  wound,  is  often 
as  fatal  as  the  external ;  the  danger  is  here  further  increased 
by  the  pressure  exerted  by  the  effused  blood  upon  a  vital 
organ,  such  as  the  brain,  as  is  witnessed  in  effusion  of  blood 
within  the  cranium,  produced  by  a  fracture  of  the  skull.  It 
is  also  exempHfied  in  a  wound  of  the  intercostal  arteries, 
causing  effusion  of  blood  into  the  chest,  and  producing  fatal 
pressure  on  the  lungs  ;  and  also  in  wounds  of  the  throat, 
resulting  in  asphyxia,  from  the  flow  of  the  blood  into  the 
windpipe. 

Shock  is  the  result  of  a  violent  impression  made  on  the 
nerve  centers.  It  often  is  the  immediate  cause  of  death, 
after  a  severe  injury,  without  leaving  any  trace  or  lesion 
discoverable  on  a  post-mortem  examination.  Shock  is 
most  apt  to  follow  extensive  lacerations  of  the  body,  such 
as  result  from  machinery  or  railway  accidents,  or  from  ex- 
tensive burns. 

The  remote  causes  of  death  from  wounds  are  numerous 
and  varied.  The  following  may  be  regarded  as  the  most 
common : 

I.  Tetanus  or  Lockjaiv.  —  This  is  generally  the  result  of 
lacerated    and   punctured  wounds,  and  is   now  known  to 


124  MEDICAL   JURISPRUDENCE. 

be  due  to  the  introduction  of  a  specific  bacillus  into  the 
tissues.  It  is  always  a  serious  complication,  and  is  mostly 
fatal.  It  does  not  usually  appear  before  the  seventh  day 
after  the  receipt  of  the  wound,  though  sometimes  earlier, 
and  rarely  later  than  the  twentieth  day.  Tetanus  is  a 
frequent  result  of  slight  wounds  of  the  hand  and  face  by  toy 
pistols  and  small  cannon.  The  manner  of  infection  is  not 
known. 

2.  Erysipelas  is  another  complication  of  wounds,  which 
may  cause  a  fatal  issue.  It  is  apt  to  accompany  wounds 
of  the  scalp  ;  and  it  sometimes  assumes  an  epidemic  char- 
acter, especially  in  hospitals,  where  it  may  occasion  great 
mortality  among  the  wounded  patients. 

3.  Hospital  gangrene  is  another  occasional  result  of 
wounds.  It,  likewise  often  proves  fatal,  and  may  assume 
an  epidemic  type.  It  is,  however,  rarely  seen  except  in 
militaiy  hospitals. 

4.  Surgical  Interference,  Including  the  Use  of  Anesthetics. — 
In  wounds  dangerous  to  life,  the  question  of  the  propriety 
of  a  surgical  operation  becomes  paramount ;  the  patient 
will  certainly  die  without  the  operation,  and,  on  the  other 
hand,  he  may  die  from  shock  as  the  immediate  result 
of  the  operation.  The  question  of  the  legal  responsibility 
of  the  death  then  becomes  a  serious  one,  and,  in  a  trial, 
counsel  may  endeavor  to  show  that  the  death  was  not  really 
the  result  of  the  wound,  but  rather  owing  to  the  surgical 
operation.  Such  an  argument  will  not  likely  avail,  unless 
it  can  be  proved  that  the  original  wound  was  not  of  a  dan- 
gerous character,  and  that  the  surgical  interference  was 
unwarrantable  and  unskillful.  The  same  remarks  will 
apply  to  the  use  of  anesthetics.  Their  employment  in 
operations  has  now  become  so  general  that  the  occasional 


SURGICAL    INTERFERENCE.  125 

fatal  results  attending  their  administration  should  be  re- 
garded as  exceptions,  in  nowise  inculpating  the  attending 
surgeon  ;  consequently,  the  fatal  result  that  might  happen 
to  follow  their  use  should  not  be  considered  as  offering  any 
extenuation  if  a  dangerous  or  fatal  wound  has  been  in- 
flicted. The  only  medico-legal  point  at  issue  would  be  — 
Was  the  administration  of  the  anesthetic  a  necessary  and 
proper  part  of  the  treatment,  and  was  it  skillfully  ad- 
ministered ? 

The  question  of  the  responsibility  of  the  surgeon  in  not 
employing  the  antiseptic  method  will  be  discussed  later, 
under  Malpractice. 

It  will  be  proper  to  devote  a  brief  consideration  to  the 
subject  of  Wounds  in  different  regions  of  the  body,  inas- 
much as  these  present  certain  individual  peculiarities,  which 
give  to  them  special  medico-legal  importance. 

Wounds  of  the  Head. — Scalp  wounds  are  not  usually 
attended  with  danger,  except  when  followed  by  erysipelas, 
or  when  the  blow  has  been  so  severe  as  to  produce  concus- 
sion of  the  brain.  Fracture  of  the  skull  may  exist  without 
any  wound  of  the  scalp  ;  and  fatal  effusion  of  blood  upon 
the  brain  may  be  produced  by  a  blow  on  the  head,  without 
caushig  either  a  visible  wound  of  the  scalp  or  a  fracture  of 
the  skull. 

Concussion  of  the  Brain  may  result  either  from  a  direct 
blow  upon  the  head,  or  from  a  violent  fall  upon  the  feet  or 
buttocks.  Sometimes  death  ensues  immediately  from  con- 
cussion, leaving  no  perceptible  lesion.  Such  fatal  concussion 
may  occur  without  either  fracture  of  the  skull  or  a  wound 
of  the  scalp.  The  symptoms  of  concussion  are  faintness, 
nausea,  vomiting,  pallor,  feeble  pulse,  partial  or  complete 
;  loss  of  consciousness,  with  confusion  of  ideas  and  tendency 


126  MEDICAL   JURISPRUDENCE. 

to  sleep.  Concussion  may  be  confounded  with  intoxica- 
tion, compression  of  the  brain,  opium  poisoning,  sun- 
stroke, etc. 

It  is  particularly  important  to  distinguish  between  con- 
cussion and  intoxication.  Many  cases  of  supposed  drunk- 
ards, arrested  in  large  cities  at  night,  and  left  unattended  in 
the  station-house  till  morning,  are,  in  reality,  cases  of  con- 
cussion or  compression  of  the  brain,  which  may  prove  fatal 
for  want  of  timely  relief.  Difficulty  of  diagnosis  is  increased 
by  the  fact  that  the  two  conditions  are  frequently  coinci- 
dent in  the  same  individual.  It  is  the  drunken  man  who  is 
most  apt  to  engage  in  a  brawl,  which  results  in  a  broken 
head.  Generally,  the  history  of  the  case  (if  it  can  be 
obtained)  and  the  odor  of  the  breath  will  afford  us  the  best 
means  of  diagnosis.  In  intoxication,  the  temperature  is 
usually  below  96°  F., — sometimes  below  90°;  the  loss  of 
power  and  sensation  is  not  unilateral,  as  in  compression  ; 
the  bladder  is  generally  full  of  limpid  urine,  which  will  fur- 
nish evidence  of  the  presence  of  alcohol.  The  pupils  are 
sometimes  contracted  and  at  other  times  dilated. 

Fracture  of  the  Skull  is  the  result  either  of  a  direct  blow 
or  a  fall  upon  the  head,  striking  a  stone  or  other  hard  body. 
The  usual  consequence  of  such  a  fracture  is  pressure  on 
the  brain  by  the  depressed  bone  or  by  extravasated  blood. 
Fracture  of  the  base  of  the  skull  is  nearly  always  fatal,  and 
unless  carefully  looked  for  in  the  autopsy,  may  escape 
notice.  It  may  result  from  a  fall  or  jump,  the  person  land- 
ing on  his  feet  or  buttocks,  and  be,  therefore,  unattended  by 
any  injury  of  the  scalp  or  face  ;  such  cases  not  uncommonly 
escape  notice  in  carelessly  conducted  post-mortems. 

Compression  of  the  Brain  may  result  either  from  effusion 
of  blood  or  serum  upon  or  within  the  brain,  with  or  without 


COMPRESSION    OF    THE    BRAIN.  12/ 

fracture  or  depression  of  the  bone  ;  also  from  suppuration 
or  tumors  in  the  brain,  from  congestion  of  the  cerebral 
vessels,  and,  likewise,  from  narcotic  poisoning.  The  symp- 
toms are  essentially  those  of  apoplexy,  viz.,  loss  of  con- 
sciousness, paralysis  (usually  hemiplegic),  dilated  pupils 
(except  where  the  effusion  is  on  the  pons  Varolii,  when, 
according  to  Wilks,  the  pupils  are  contracted),  stertorous 
breathing,  a  full,  slow  pulse,  and  coma.  It  is  important  to 
remember  that  the  effusion  of  blood  resulting  from  a  blow 
may  be  gradual,  so  that  the  person  seemingly  recovers  from 
the  first  shock,  and  may  be  able  even  to  resume  his  ordi- 
nary occupation  for  some  hours,  or  even  days,  before  the 
fatal  termination  occurs.  The  distinction  between  the 
effusion  from  violence,  and  that  resulting  from  disease,  is,  as 
a  rule,  that  in  the  former  the  extravasation  is  nearly  always 
between  the  skull  and  the  dura  mater,  or  between  this  mem- 
brane and  the  brain,  while  in  the  latter  it  is  usually  in  the 
brain  substance.  Moreover,  in  the  first  there  is  frequently 
a  fracture  of  the  bone  and  ecchymosis  of  the  scalp,  either 
immediately  over  the  effusion  or  on  the  oppo.site  side  of  the 
head  (counter-stroke). 

Another  important  point  is  that  a  fatal  effusion  of  blood 
may  take  place  simply  from  great  excitement,  especially  if 
associated  with  intoxication.  This  may  be  urged  as  the 
probable  cause  of  death  where  there  has  been  an  assault  by 
a  blow  upon  the  head  which  terminated  fatally.  In  such 
a  case  it  may  be  difficult  to  decide  how  far  the  fatal  effusion 
was  due  to  natural  causes,  such  as  atheroma  of  the  cerebral 
arteries  (which,  in  a  habitual  spirit-drinker,  might  also  be 
connected  with  diseased  liver  and  kidneys),  or  how  far  it 
was  to  be  attributable  directly  to  the  effects  of  violence. 
However,  if  the   assault   can  be  clearly  proven,  either  in 


128  MEDICAL    JURISPRUDENCE. 

connection  with  a  direct  blow  upon  the' head,  or,  indirectly, 
by  a  fall  upon  a  stone  or  other  hard  body,  the  mere  fact  of 
the  preexisting  disease  of  the  arteries  or  the  other  organs 
should  not  lead  to  the  view  that  the  violence  had  no  relation 
to  the  fatal  result ;  but  if  the  autopsy  show  that  the  effused 
clot,  or  serum,  was  of  older  date  than  the  alleged  injury, 
this  would  certainly  be  a  strong  argument  for  regarding  the 
death  as  due  to  the  diseased  condition. 

Wounds  of  the  substance  of  the  Brain  are  not  always  fatal. 
It  is  well  known  that  considerable  portions  of  the  cerebral 
substance  have  escaped  through  the  skull,  not  only  without 
loss  of  life,  but  without  serious  discernible  impairment  of 
the  mental  powers. 

Wounds  of  the  Face  are  not  usually  dangerous  unless  they 
involve  the  orbit ;  a  penetrating  wound  of  this  part  may 
readily  reach  the  brain,  with  a  fatal  result.  So,  also,  a 
severe  blow  upon  the  nose  may  so  injure  the  ethmoid  bone 
as  subsequently  to  involve  the  brain. 

Wounds  of  the  Neck  are  attended  with  much  danger, 
owing  to  the  presence  of  the  large  vessels  and  nerves.  In 
cut  throats,  the  great  danger  arises  from  the  sudden  and 
profuse  hemorrhage.  The  section  of  the  larynx  and  trachea 
is  not  necessarily  fatal,  the  chief  danger  arising  from  suffo- 
cation from  the  flowing  back  of  the  blood.  A  division  of 
the  esophagus  is  almost  necessarily  fatal,  chiefly  because  of 
its  involving  the  section  of  the  great  vessels  of  the  neck. 

Wonnds  of  the  Spine  are  dangerous  in  proportion  to  the 
degree  in  which  the  spinal  marrow  is  involved.  In  concus- 
sion of  the  spine,  death  sometimes  takes  place  instantly.  If 
the  spinal  cord  be  wounded  high  up,  above  the  region  of 
the  phrenic  nerve,  the  function  of  respiration  is  immediately 
arrested,  and  death  ensues.      Wherever  the   injury  occurs 


WOUNDS    OF    THE    SPINE.  1 29 

to  the  Spinal  cord,  it  is  understood  that  there  is  a  complete 
suspension  of  the  functions  of  the  parts  below.  In  fracture 
of  the  vertebrae,  the  great  danger  arises  from  pressure  on 
the  spinal  marrow.  Sudden  death  has  been  produced  by 
the  spontaneous  luxation  of  the  second  cervical  vertebra, 
arising  from  the  fracture  of  the  odontoid  process,  through 
disease.  Sir  Astley  Cooper's  case  was  of  this  character. 
These  fractures  have  an  important  medico-legal  bearing. 

Wo7mds  of  the  Chest.  —  The  great  danger  here  lies  in  the 
hemorrhage  from  the  heart,  great  vessels,  and  lungs ;  hence, 
such  wounds  often  prove  rapidly  fatal.  The  hemorrhage 
in  wounds  of  the  chest  is  nearly  always  internal.  Wounds 
of  the  lungs,  though  they  may  not  prove  immediately  fatal, 
frequently  so  terminate  after  a  lapse  of  time  ;  this  is  espe- 
cially true  of  gunshot  wounds,  if  the  bullet  or  other  foreign 
substance  happens  to  be  retained.  IVoinids  of  the  Heart, 
if  the  cavities  be  penetrated,  always  terminate  fatally  and 
rapidly.  Gunshot  wounds  of  the  heart  do  not  necessarily 
cause  immediate  death  ;  cases  are  recorded  where  the  patient 
survived  several  months  ;  after  death  the  ball  has  been  found 
in  the  substance  of  the  organ.  Even  where  the  cavities  of 
the  heart  have  been  perforated  by  a  cutting  instrument, 
there  have  been  instances  where  the  person  survived  for 
several  days.  Rupture  of  the  heart  may  be  the  result  of  a 
violent  blow  upon  the  thorax,  or  it  may  follow  any  intense 
excitement,  exertion,  or  emotion,  if  this  organ  happens  to 
be  in  a  diseased  condition.  Where  death  has  resulted  in  a 
brawl  in  which  the  deceased  received  a  severe  blow  on  the 
chest,  if  the  preexisting  disease  of  the  organ  can  be  estab- 
lished, it  would  be  a  question  how  far  the  violence  and  how 
far  the  disease  was  to  be  credited  with  the  result.  The 
case  is  very  similar  to  the  one  where  death  follows  a  blow 
II 


130  MEDICAL    JURISPRUDENCE. 

upon  the  head,  terminating  in  compression  of  the  brain, 
and  where  a  diseased  condition  of  the  cerebral  vessels 
existed. 

Wounds  of  the  Abdomen. — Even  a  superficial  wound  of 
the  abdomen  may  prove  fatal  by  dividing  the  epigastric 
artery.  A  severe  blow  upon  the  epigastric  region  has  fre- 
quently produced  immediate  death,  by  action  upon  the 
solar  plexus  of  nerves.  Blows  upon  any  part  of  the  abdo- 
men may  be  followed  by  peritoneal  inflammation,  which 
often  proves  fatal.  Penetrating  or  perforating  wounds  may 
terminate  fatally  from  the  same  cause.  Wounds  of  the 
stomach  and  intestines,  though  more  satisfactorily  treated 
of  late  years  by  the  improved  antiseptic  methods,  are  dan- 
gerous and  often  fatal,  either  from  hemorrhage  or  inflam- 
mation   or  both. 

Wonnds  of  the  Liver  are  dangerous,  according  to  their 
extent  and  depth.  If  the  gall-bladder  is  involved,  death  is 
apt  to  ensue  in  consequence  of  the  peritonitis.  The  danger 
from  Wounds  of  the  Kidneys  arises  from  the  effusion  of  urine, 
and  the  consequent  inflammation. 

In  relation  to  Wonnds  of  the  B'adder,  it  should  be  re- 
membered that  this  organ  may  be  ruptured  spontaneously 
from  over-distention.  It  is  sometimes  ruptured  by  a  blow 
or  kick  of  a  horse  upon  the  lower  part  of  the  abdomen. 
In  a  case  of  death  produced  by  rupture  of  the  bladder,  it 
might  be  sought  to  set  up  the  plea  of  spontaneous  rupture 
of  the  organ.  Frequently  there  is  no  external  injury  to 
indicate  the  true  nature  of  the  case,  the  autopsy  alone  re- 
vealing it,  and  disclosing,  also,  extensive  peritoneal  inflam- 
mation, resulting  from  the  escape  of  urine. 

Wounds  of  the  Genital  Organs  are,  in  the  male,  usually 
self-inflicted,  and  they  are  met  with  most  generally  among 


WOUNDS    OF    THE    GENITAL    ORGANS.  I3I 

the  insane.  They  comprise  castration,  more  or  less  com- 
plete, and  amputation  of  the  penis,  partial  or  entire.  The 
danger  to  life  is  great  in  proportion  to  the  hemorrhage  and 
injury  to  the  organs.  In  certain  other  cases,  where  the 
injury  has  been  inflicted  by  others,  and  when  in  a  state  of 
erection,  the  urethra  has  been  found  violently  torn  across,  and 
the  corpora  cavernosa  and  spongiosa  divided.  In  females,  the 
chief  point  of  medico-legal  interest  is  to  discriminate  between 
wounds  of  the  genitals  inflicted  by  another,  and  spontaneous 
hemorrhages  from  a  ruptured  vein  in  the  labia.  Here,  of 
course,  a  rigid  inspection  of  the  injured  parts  will  be  needed. 

Examination  of  Blood  Stains. — The  identification  of 
blood  stains  not  infrequently  constitutes  a  most  important 
link  in  the  chain  of  evidence  in  a  trial  for  homicide.  It  is  a 
very  common  practice  for  a  murderer  to  attribute  certain  sus- 
picious red  stains  discovered  upon  his  garments  or  imple- 
ments, to  spots  of  red  paint,  fruit  stains,  or  to  the  blood 
of  some  domestic  animal  or  bird. 

To  the  naked  eye  -blood  stains  will  vary  in  size,  shape, 
and  color.  They  may  be  mere  films  or  smears,  but  gener- 
ally present  the  form  of  distinct  spots  of  different  sizes  ;  and 
if  the  blood  has  spurted  from  an  artery  obliquely  upon  a 
surface,  the  spots  will  have  assumed  a  comet-like  shape, 
terminating  in  a  bulbous  tail.  The  color  of  the  satin  will 
depend  :  ( i )  Upon  its  freshness  :  if  recent,  it  will  have  a  bright 
red  hue ;  if  old,  the  color  will  be  brownish,  or  brown  red. 
(2)  Upon  its  thickness  ;  being  darker  in  proportion  to  the 
density  of  the  stain.  (3)  Upon  the  material  on  which  it  has 
fallen  :  if  the  latter  is  porous,  as  soft  wood,  or  linen,  or  cot- 
ton fabrics,  the  tint  will  be  rather  dull ;  but  if  on  polished 
and   hard  substances,   such  as  metals,  glass,   or  polished 


132  MEDICAL   JURISPRUDENCE. 

wood,  the  spots  have  a  darker  and  shining  appearance,  and 
on  drying  they  are  apt  to  crack  from  the  center,  and  may 
thus  be  easily  removed.  When  dried  upon  linen  or  cotton, 
they  usually  have  a  stiffened  feel,  like  a  spot  of  dried  albu- 
min or  gum.  If  the  stains  be  upon  a  colored  substance, 
they  can  best  be  distinguished  by  artificial  light ;  indeed, 
they  may  be  entirely  invisible  in  bright  daylight.  While  it 
is  not  always  possible  to  even  proximate  the  age  of  a  blood 
stain,  conclusions  of  great  value  may  be  drawn  from  a  care- 
ful examination.  If  a  clot  or  stain  has  been  worn  it  will  be 
polished,  not  uncommonly,  greasy,  and  intermixed  with 
dirt.  If  it  is  old  and  unworn,  it  may  be  dry  and  fragile  ; 
unless  mixed  with  dirt  and  grease  recent  clots  are  flexible 
and  fracture  with  difficulty. 

We  possess  several  methods  of  identifying  blood  stains  : 
(i)  the  chemical ;  (2)  the  microscopic  ;  (3)  the  spectroscopic. 
But  previously  to  employing  these  methods,  it  will  be 
always  proper  to  examine  the  suspected  spot,  if  not  too 
much  covered  with  dirt,  with  a  good  magnifier ;  the  spot,  if 
a  blood  stain,  will  frequently  exhibit  minute  coagula  or 
clots  of  a  shiny  hue,  intermixed  with  the  fibers  of  the  ma- 
terial on  which  it  is  fixed. 

I.  The  Chemical  Tests. — Before  noticing  these,  it  will 
be  proper  to  remark  briefly  on  the  solubility  of  the  coloring 
matter  of  blood.  Modern  research  has  shown  that  the  col- 
oring matter  of  blood  (hemoglobin)  when  quite  recent,  is 
very  soluble  in  cold  water ;  but  when  so  old  as  to  have 
changed  to  a  brown  color,  it  is  converted  into  hematin, 
which  is  insoluble  in  water.  This  is  a  fact  of  considerable 
importance.  For  if  a  garment  or  other  article  is  washed 
in  cold  water  immediately  after  being  stained  with  blood, 


CHEMICAL    TESTS    FOR    BLOOD.  1 33 

the  blood  will  probably  be  discharged  so  as  to  leave  no 
trace  ;  but  if  the  garment  be  kept  for  some  time  before  the 
attempt  is  made  to  remove  the  stain  by  washing,  the  soluble 
hemoglobin  will  have  become  more  or  less  associated  with 
the  insoluble  hematin,  and  enough  of  the  blood  will  remain 
upon  the  article  to  suffice  for  future  identification.  Hot 
water  will  not  remove  a  recent  blood  stain  as  effectually  as 
cold  water,  on  account  of  the  action  of  the  heat  upon  the 
hemoglobin,  changing  it  into  hematin. 

If  the  blood-spot  be  recent,  and  there  be  sufficient  ma- 
terial, the  examiner  should  cut  out  a  small  piece  of  the 
stained  fabric,  and  suspend  it  by  means  of  a  thread  in  a 
test-tube  containing  cold  distilled  water.  In  a  few  minutes 
the  coloring  matter  will  be  observed  to  separate  from  the 
material  and  to  descend  to  the  bottom  of  the  water,  form- 
ing a  bright-red  solution.  If  the  stain  is  a  little  older,  more 
time  will  be  required  to  effect  the  solution,  which  will  have 
a  browner  hue  ;  and  if  the  stain  is  very  old,  there  will  be  no 
solution  whatever. 

If  the  stain  be  upon  a  porous  substance,  such  as  wood, 
brick,  etc.,  it  should  be  cut  or  scraped  out,  reduced  to 
powder,  and  then  soaked  in  cold  water  for  some  hours  and 
afterward  filtered.  If  the  spot  be  upon  a  hard  metallic  sur- 
face, as  a  knife,  sword,  etc.,  it  should  be  carefully  dried, 
when  it  will  be  apt  to  crack  off;  if  not,  it  may  be  scraped 
off  with  a  knife.  The  scraping  should  be  soaked  for  some 
time  in  cold  water  and  filtered.  If  the  solution  should  not 
be  complete,  a  little  dilute  ammonium  hydroxid  may  be 
added,  and,  if  this  should  fail.  Tidy  recommends  using  a 
trace  of  citric  acid  to  effect  the  solution. 

Having  procured  the  clear  red  solution,  the  next  step  is 
to  heat  it  in  a  test-tube  over  a  spirit  lamp ;  the  following 


134  MEDICAL    JURISPRUDENCE. 

results  are  thus  obtained:  (i)  the  red  color  disappears; 
(2)  coagulation  takes  place  ;  (3)  a  brownish-green  precipi- 
tate is  formed.  If  there  is  sufficient  quantity  of  this  pre- 
capitate,  it  may  be  collected,  dried,  and  heated  with  a  weak 
ammonium  hydroxid  solution,  which  will  dissolve  it ;  the 
solution  will  appear  dark  green  by  reflected  and  red  by 
transmitted  light.  (4)  Dilute  ammonium  hydroxid  added 
to  the  original  solution  either  produces  no  change  of  color, 
or  it  merely  intensifies  it ;  it  never  changes  it  to  green  or 
crimson,  as  it  does  with  cochineal  and  red  fruit  colors. 
Tannin  gives  a  red  precipitate  with  the  original  solution. 
A  solution  of  chlorin  causes  no  change. 

The  above  tests  will  suffice  to  distinguish  blood  from 
many  red  solutions,  such  as  cochineal,  kino,  madder,  log- 
wood, and  the  various  red  fruit-juices,  none  of  which  coagu- 
late by  heat,  and  all  of  which  are  changed  in  color  by  the 
addition  of  ammonium  hydroxid.  The  stain  produced  by 
lemon  or  orange  juice  on  the  blade  of  a  knife,  after  exposure 
to  the  air,  may  bear  some  resemblance  to  an  old  blood  stain ; 
but  the  tannin  test  of  the  solution  would  immediately  detect 
the  difference.  So,  the  stain  from  red  paint  (which  con- 
tains iron)  or  from  iron-mold  is  easily  identified  by  its  solu- 
bility in  dilute  dydrochloric  acid,  and  subsequent  indication 
of  iron. 

T!ie  Guaiacum  Test  constitutes  a  beautiful  and  satisfac- 
toiy  chemical  test  for  blood.  It  depends  upon  the  follow- 
ing conditions :  A  freshly-prepared  tincture  of  guaiacum,  if 
dropped  into  water,  precipitates  the  resin,  which,  if  exposed 
to  the  air,  gradually  acquires  a  bluish  color.  If  it  be  exposed 
to  a  jar  of  oxygen  gas,  the  bluing  process  is  more  rapid  ; 
and  if  brought  in  contact  with  ozone,  the  blue  color  is 
instantly  produced.     Hence,  the  bluing  must  be  owing  to 


THE    GUAIACUM    TEST.  1 35 

oxidation.  Moreover,  while  the  resin  is  blued  by  a  variety 
of  mineral  and  organic  substances,  the  coloring  matter  of 
the  blood  has  no  effect  upon  it.  The  guaiacum  test  de- 
pends, then,  upon  the  fact  that  while  the  blood  has  no 
power  to  oxidize  or  blue  the  resin,  the  presence  of  hydrogen 
dioxid,  which  itself  has  no  power  to  oxidize  the  guaiacum, 
causes  the  resin  then  to  be  oxidized  by  the  blood,  and  the 
blue  color  appears.  According  to  Taylor,  an  excellent  way 
of  showing  the  experiment  is  to  add  a  few  drops  of  the  tinc- 
ture (freshly  prepared  from  portions  of  the  resin  taken  from 
the  center  of  a  lump)  to  a  small  quantity  of  water  ;  this 
will  precipitate  the  resin.  Divide  the  water  suspending  the 
resin  into  two  portions  ;  into  one  of  them  pour  a  little  solu- 
tion of  red  coloring  matter  of  blood  ;  to  the  other  add  a 
(ew  drops  of  hydrogen  dioxid  solution  (see  below) ;  no 
change  of  color  is  observed  in  either  portion.  Now,  to  the 
first  portion  add  a  few  drops  of  the  hydrogen  dioxid  solution, 
and  to  the  second  a  few  drops  of  the  red  solution  ;  in  both 
cases  the  sapphire-blue  color  will  soon  be  seen.  In  case 
the  solution  is  turbid  from  an  excess  of  the  resin,  the  addi- 
tion of  a  few  drops  of  alcohol  will  instantly  clear  it  and 
bring  out  the  fine  blue  color  distinctly.  If  the  simple  addi- 
tion of  the  blood  solution  to  the  guaiacum  produces  a  blue 
color,  we  may  be  certain  that  some  oxidizing  substance  is 
present  besides  blood,  and  which  conceals  its  presence.  The 
force  of  the  experiment  consists  in  the  fact  that  blood,  of 
itself,  will  not  blue  guaiacum  ;  but  in  the  presence  of  hydro- 
gen dioxid  the  blue  color  is  speedily  produced. 

Care  should  be  taken  to  use  a  good  quality  of  hydrogen 
dioxid  solution.  There  is  much  sold  which  is  practically 
worthless. 

Objections    have    been    raised   against    this   test   on   the 


136  Medical  jurisprudence. 

ground  that  other  substances  besides  blood  will  produce 
a  blue  color  in  the  presence  of  guaiacum  and  hydrogen 
dioxid,  such  as  saliva,  bile,  and  red  wine ;  but  as  regards 
the  two  former,  their  color  should  at  once  distinguish  them 
from  blood,  while  the  latter  substance  requires  exposure  for 
some  hours  to  produce  the  same  result ;  whereas,  in  the 
case  of  blood  the  effect  is  immediate.  This  test  is  as  avail- 
able for  old  as  for  fresh  blood,  for  concentrated  or  diluted 
blood  ;  hence,  for  a  washed-out  blood  stain  —  wherever,  in 
fact,  a  particle  of  red  coloring  matter  remains.  If  no  bluing 
occurs  in  the  presence  of  the  guaiacum  and  the  dioxid,  it 
will  be  safe  to  affirm  that  there  is  no  blood  present.  With 
an  old  blood  stain,  or  one  that  is  too  small  to  afford  a  suffi- 
cient solution,  or  where  there  may  be  some  doubt  of  its 
presence  on  a  colored  material,  a  very  good  plan  is  to 
moisten  the  spot  first  with  a  few  drops  of  water,  then  with  a 
sufficient  quantity  of  the  guaiacum  tincture,  and  afterward 
with  a  few  drops  of  the  dioxid,  and  then  press  upon  it  a 
piece  of  white  tissue  or  filtering  paper ;  immediately  there 
will  appear  upon  the  paper  the  characteristic  blue  stain.  A 
number  of  such  impressions  may  thus  be  taken  from  one 
spot,  by  simply  adding  a  little  more  of  the  guaiacum  and 
the  ether,  and  repeating  the  pressure  upon  the  paper. 

It  is  known  that  many  substances  other  than  blood  will 
cause  the  reaction.  Among  these  are  compounds  contain- 
ing iron  (ferric),  copper,  manganese,  and  gold,  also  glue, 
casein,  and  potato  skin.  It  is  obvious  that  many  of  these 
substances  will  not  be  encountered  in  actual  medico-legal 
work  and  with  others  the  interference  can  be  easily  avoided. 
It  is  also  stated  that  cloth  dyed  with  indigo  will  simulate 
blood.  The  test  is  not  to  be  relied  on  by  itself  It  is  an 
excellent  preliminary  test.     A  negative  result  shows  that 


HEMIN    CRYSTALS.  l^^ 

blood  pigment  in  a  soluble  form  is  not  present ;  a  positive 
result  will  not  prove  the  presence  of  blood. 

Heniin  Crystals. — The  production  of  these  (known  as 
Teichmann's  test)  is  proof  of  the  presence  of  blood,  but 
does  not  distinguish  human  from  other  blood.  A  small 
portion  of  the  material  to  be  tested  is  placed  on  a  micro- 
scope slide,  a  drop  of  water  added,  and  a  minute  fragment 
of  sodium  chlorid.  The  slide  is  then  heated  to  diyness 
on  the  steam  bath,  the  residue  covered  with  a  cover-glass, 
and  a  drop  of  glacial  acetic  allowed  to  run  under  this.  The 
slide  is  again  heated  until  bubbles  arise  under  the  cover- 
glass.  It  is  then  allowed  to  cool,  when  the  hemin  crystals 
will  form.  (E.  S.  Wood,  WittJiaus  and  Becker,  Med.  Jur. 
and  Tax.) 

Serum  Test. — The  following  account  of  this  test  is  taken 
from  an  article  by  Prof  E.  S.  Wood,  of  Harvard  College, 
in  Boston  Med.  and  Surg.  Jour.,  April  24,  1902.  If  a  rabbit 
is  treated  with  about  half  a  dozen  injections  of  ten  c.c.  each 
of  human  blood  or  blood  serum,  the  injections  being  into 
the  peritoneal  cavity  and  performed  at  intervals  of  several 
days,  the  blood  of  the  animal  develops  a  substance  which 
has  been  termed  "precipitin,"  that  causes  a  precipitate  in 
human  blood  or  blood  serum,  but  not  in  that  of  any  other 
animal  except  possibly  some  of  the  apes.  For  a  description 
of  the  method  of  preparing  the  animal  reference  may  be 
made  to  a  paper  by  Dr.  W.  F.  Whitney  in  the  journal 
quoted  above.  After  the  rabbit  is  "  humanized,"  it  is 
allowed  to  rest  for  about  a  week  and  then  some  blood 
drawn  from  it.  A  little  from  one  of  the  large  veins  of  the 
ear  will  serve.  This  is  placed  in  a  cool  place  and  allowed 
to  coagulate,  the  serum  being  used. 

If  fresh  blood  is  to  be  tested,  it  is  to  be  diluted  to  abf 


138  '  MEDICAL    JURISPRUDENCE. 

i-ioo  with  normal  salt  solution.  The  liquid  thus  obtained 
should  have  a  Hght  pink  tint  and  if  not  clear  should  be 
allowed  to  settle  completely  and  the  supernatant  fluid  de- 
canted. Dry  blood  stains  should  be  scraped  off  on  to  a 
watch  glass  if  upon  non-porous  materials  ;  if  on  a  porous 
material,  a  small  piece  of  this  should  be  cut  out.  The  ma- 
terial is  treated  with  a  few  drops  of  distilled  water  until  all 
soluble  matter  has  been  taken  up.  The  clear  solution  is 
transferred  to  a  very  narrow  test-tube  and  mixed  with  an 
equal  volume  of  double  normal  salt  solution.  The  liquid 
is  then  tested  by  adding  to  it  a  few  drops  of  the  humanized 
serum.  If  the  solution  contains  human  blood  serum  there 
will  be  obtained  promptly  a  precipitate,  at  first  very  slight 
but  in  about  thirty  minutes  it  will  be  distinct.  The  reaction 
occurs  best  at  blood  heat.  The  manipulation  is  best  per- 
formed by  allowing  the  rabbit  serum  to  flow  down  the  side 
of  the  tube  and  underlay  the  liquid  to  be  tested.  The  pre- 
cipitate can  then  be  seen  at  the  point  of  contact. 

It  should  be  observed  that  the  chemical  tests  will  not  dis- 
tinguish arterial  from  venous  blood. 

II.  The  Microscopic  Test. — This  consists  in  the  identi- 
fication of  the  blood  corpuscles  —  especially  the  red  ones  — 
by  means  of  the  microscope. 

The  class  of  stains  adapted  for  microscopic  examination 
are  those  in  which  decomposition  has  not  taken  place.  If 
the  stain  upon  the  garment  has  been  moist,  or  submerged 
in  water  for  a  considerable  time,  decomposition  may  have 
led  to  the  dissolution  of  the  corpuscles,  and  hence  interfere 
with  the  microscopic  examination  of  the  blood.  Such 
materials  containing  blood  will  offer  the  best  results  to  the 
chemical   and  spectroscopic  methods.      Of  the  other  class 


THE    MICROSCOPIC    TEST. 


139 


of  stains  submitted  for  examination,  they  will  be  either  (i) 
fresh,  that  is  stains  which  have  not  died,  and  in  which  the 
blood  may  or  may  not  be  coagulated,  and  (2)  dry  stains, 
which  will  be  hereafter  referred  to  as  "  old  stains." 

In  the  examination  of  the  fresh  stains,  it  will  only  be 
necessary  to  make  a  thin  spread  upon  a  glass  slide  and 
allow  it  to  dry.  This  is  usually  best  accomplished  by 
placing  the  moist  blood  upon  the  slide  and  sweeping  the 
edge  of  another  slide  over  it,  thus  scattering  the  blood  in  a 
thin  layer,  which  must  be  allowed  to  dry  and  can  be 
examined  at  leisure  and  preserved  indefinitely. 

For  the  examination  of  dried  stains,  the  following  re- 
agents and  apparatus  will  be  needed  : — Chemically  clean 
sHdes  and  cover-glasses,  an  alcohol  lamp,  a  sharp  knife  of 
solid  metal  (so-called  antiseptic  handle),  a  microscopic 
needle,  and  a  small  oiler  with  clean  oil.  A  moist  chamber, 
such  as  is  used  in  bacteriologic  work,  may  be  of  use.  The 
reaeents  will  be  — 


(ist)    Water 


(2d)    Potassium  hydroxid.  .     I  part. 
Water 2  parts. 

(3d)    Miiller's  fluid  : — 

Potassium  dichromate  I  part. 
Sodium  sulphate  .  .  2  parts. 
Water.   ......  100  parts. 


(4th)    Muller's  fluid 
Glycerol,  q.  s. 

The  glycerol  is  added  until  a  sp. 
gr.  of  1028  is  obtained, 

(5th)    Glycerol i  part. 

Water 6  parts. 

(6th)    Sodium  sulphate.  .    .    6  parts. 
Water 8  parts. 


The  blood  stains  to  be  examined  will  be  upon  bibu- 
lous materials  or  non-bibulous  materials.  The  first  includes 
clothing,  wood  (unvarnished  or  unpainted),  carpets,  and 
similar  materials.     The  second  includes  metallic  weapons, 


140  MEDICAL    JURISPRUDENCE. 

buttons,  glass,  chinaware,  highly  polished  and  painted 
woodwork,  etc. 

In  searching  for  the  stains  upon  bibulous  materials,  an 
ordinary  hand  glass  or  a  two-inch  objective  may  be  used 
to  advantage.  The  light  demanded  will  depend  upon  the 
color  and  character  of  the  goods,  so  that  it  may  be  neces- 
sary to  try  bright  and  diffused  daylight  and  artificial  light. 
The  blood  spots,  when  found,  may  consist  of  distinct  drops, 
smears,  or  smudges,  and  stains  which  have  been  influenced 
by  the  dilution  of  the  blood,  such  as  by  washing  the  stain 
or  stains  which  have  fallen  upon  a  wet  garment,  or  a  gar- 
ment which  has  been  made  wet  before  coagulation  or  diy- 
ing  of  the  blood  took  place.  It  is  to  be  remembered  that 
the  more  rapidly  the  blood  dries,  the  better  it  will  be  pre- 
served, and  for  this  reason  the  best  cells  will  be  obtained 
from  the  smaller  clots  or  diffused  smudges,  or  stains  which 
have  dried  rapidly. 

To  prepare  a  slide  for  examination,  the  suspected  spot  in 
clothing,  for  example,  is  bent  and  laid  upon  a  glass  slide, 
which  has  previously  been  breathed  upon,  in  order  to  make 
it  sufficiently  moist  to  cause  the  adhesion  of  the  small  par- 
ticles which  may  fall  upon  it.  The  knife  blade  is  then 
passed  through  the  flame  of  an  alcohol  lamp,  in  order  to 
destroy  any  organic  material  which  may  adhere  to  it ;  then 
the  surface  of  the  cloth  is  gently  scraped  with  the  knife 
blade,  until  a  thin  layer  of  the  broken-up  stain  is  distinctly 
visible  to  the  naked  eye  upon  the  slide.  A  cover-glass  is 
then  dropped  on  this,  and  one  of  the  above  solutions 
allowed  to  flow  under  from  the  margin  until  it  has  dispersed 
the  air  from  beneath  the  cover-glass,  at  least  most  if  not  all 
the  air. 

The  slide  may  be  examined   immediately ;    but,  if  it  is 


THE    MICROSCOPIC    TEST.  I4I 

necessary  to  allow  it  to  soak  for  any  length  of  time,  the 
evaporation  of  the  fluid  may  be  prevented  by  running 
around  the  margin  of  the  glass  a  small  quantity  of  oil  — 
ordinary  machine  oil  being  applicable  for  this  purpose. 
The  fluid  containing  glycerol  and  the  potassium  hydroxid 
solution  do  not,  as  a  rule,  require  this  precaution  except  in 
very  warm  and  dry  weather,  or  when  the  slide  is  placed  in 
a  moist  chamber  and  allowed  to  digest.  It  is  better  to  pre- 
pare a  series  of  slides  from  each  stain,  using  different  fluids, 
because  some  stains  will  react  differently  with  different 
fluids. 

The  stains  on  non-bibulous  surfaces  may  be  chipped  off 
by  means  of  a  knife  or  small  needle,  placed  upon  a  slide 
and  broken  up,  a  cover-glass  dropped  on,  and  then  treated 
as  already  described  for  stains  on  bibulous  materials.  Be- 
fore preparing  any  slide,  and  between  the  examination  of 
any  two  spots,  the  knife  or  needle  should  be  heated  in  order 
to  destroy  any  corpuscles  which  may  have  adhered  from  a 
previous  examination.  The  time  necessary  for  the  corpus- 
cles to  resolve  will  vary  from  a  few  minutes  to  twelve  hours, 
in  most  cases,  and  rarely  be  twenty-four  or  forty-eight 
hours.  During  the  interval,  however,  frequent  examina- 
tions should  be  made,  lest  the  corpuscles  swell  up  and 
oval  ones  become  round,  and  round  ones  entirely  disappear. 

In  all  cases  it  is  proper  to  make  a  measurement  of  the  cor- 
puscles, and  in  order  to  do  this,  two  micrometers  will  be 
needed  —  one  known  as  the  the  stage  micrometer,  ruled  in 
ToVo"  *-*^  ^^  inch,  and  the  other  an  eye-piece  micrometer,  ruled 
with  equidistant  parallel  lines,  usually  yig-  of  an  inch  apart, 
although  this  is  not  a  matter  of  any  great  importance,  as 
the  eye-piece  micrometer  must  be  standardized  before  each 
observation.     To  accomplish  this  the  eye-piece  micrometer 


142  MEDICAL    JURISPRUDENCE. 

should  be  placed  in  the  eye-piece,  and  the  stage  microm- 
eter upon  the  stage  of  the  microscope,  and  the  lens  and 
length  of  tube  so  adjusted  as  to  give  thirty-two  lines 
of  the  eye-piece  micrometer  between  the  lines  of  ^^o"  °^ 
an  inch  ruling  on  the  stage  micrometer,  or  ten  of  the  -^-^qq 
of  an  inch,  which  is,  of  course,  equivalent.  Artificial  light 
is  best,  as  it  can  be  regulated.  Very  accurate  measure- 
ments can  be  made  by  this  method. 

The  blood  corpuscles  of  man  and  most  of  the  mammals 
are  circular,  biconcave  disks  without  nuclei.  The  excep- 
tion to  this  is  in  the  corpuscles  of  the  camel  and  llama, 
which  are  oval  but  without  nucleus.  The  blood  corpuscles 
of  reptiles,  birds,  and  fishes  are  oval  and  have  a  nucleus, 
with  the  exception  of  the  lamprey,  in  which  the  corpuscles 
are  circular,  but  nucleated.  By  reference  to  the  accom- 
panying table,  there  will  be  little  difficulty  in  differentiating 
corpuscles  belonging  to  mammals  from  those  of  reptiles, 
birds,  and  fishes. 

That  human  corpuscles  are  altered  by  some  diseases,  does 
not  militate  against  the  microscopic  examination.  There 
is  no  disease  in  which  the  mammalian  characteristics  are 
entirely  lost,  and  in  which  an  expert  microscopist  would  be 
hkely  to  be  misled.  In  pernicious  anemia,  leukemia,  pur- 
pura, yellow  fever,  and  allied  diseases,  the  blood  undergoes 
important  changes,  but  this  does  not  disguise  the  character- 
istic appearance  of  blood  corpuscles.  It  is  not  deemed 
necessary  to  go  into  any  discussion  over  the  question 
whether  the  expert  can  differentiate  the  blood  of  a  human 
being  from  that  of  other  mammals  ;  sufficient  to  say  that  all 
the  expert  can  consistently  do,  in  the  present  state  of  our 
knowledge,  is  to  say  that  the  blood  is  mammalian  blood, 
and  from  his  examination  and  measurements  it  is  consistent 
with  human  blood. 


THE    MICROSCOPIC    TEST.  I43 

Sources  of  Error.  —  In  making  the  examination  it  is  to 
be  remembered  that  solutions  of  the  same  specific  gravity 
of  the  blood,  or  lighter,  will  lead  to  the  eventual  swelling 
up  and  dissolution  of  the  corpuscles,  and  that  from  long 
soaking  oval  corpuscles  may  become  circular  from  the 
imbibition  of  water.  Certain  vegetable  structures,  notably 
sporules  and  some  algae,  may  resemble  blood  cells  ;  but  the 
vegetable  cell  is  not  biconcave  and  has  not  the  translucency 
of  the  animal  cell,  and  prolonged  soaking  does  not  alter  it 
as  it  does  the  blood  corpuscle. 

The  following  tables  present  a  synopsis  of  recent  trust- 
worthy measurements  of  the  blood  corpuscles  of  various 
animals  : 


144 


MEDICAL   JURISPRUDENCE. 


COMPARATIVE   SIZE   OF   BLOOD   CORPUSCLES. 

(The  figure  is  the  denominator  ;  the  numerator  is  always  tinity.) 


Observer. 

Animal. 

J 

&• 

•d 

2.§a 

0  2  3 

Appearance  of 

Cell. 

> 
O 

1 
0 

i 

3200 

Man    .... 

3200 

3250 

3200 

Biconcave  disk 
nucleus. 

without 

Guinea  Pig     . 

3538 

3223 

3400 

3500 

n 

Wolf  .... 

3600 

3422 

3450 

3600 

" 

Dog    .    . 

3532 

3561 

3580 

3500 

" 

Rabbit    . 

3607 

3653 

3662 

3600 

" 

Ox  .    .    . 

4267 

4219 

4200 

4200 

" 

Pig      .    . 

4230 

4268 

4250 

4200 

<( 

Horse 

4600 

4243 

4310 

4500 

<( 

Sheep 

5300 

4912 

5000 

5000 

(( 

Goat 

6366 

6189 

6100 

6100 

li 

Monkey  . 

3412 

3382 

3400 

3400 

If 

Kangaroo 

3440 

3410 

3400 

3400 

" 

Beaver    . 

3325 

.    . 

3325 

3300 

" 

Seal     .    . 

3281 

3200 

3200 

11 

Walrus    . 

2769 

2700 

11 

Elephant 

2745 

2738 

2700 

" 

Great  Ant-] 

Eater 

2769 

2700 

" 

Capybara 

3190 

3164 

3100 

" 

Sloth  .    . 

2865 

■    • 

2800 

" 

Whale    . 

3099 

3000 

" 

Opossum 

3557 

3145 

3500 

" 

Cat      .    . 

4404 

4372 

4400 

<< 

Musk  Rat 

3550 

3282 

3500 

" 

^        ,         f  Long  diameter 
C^-^1-     {short        " 

3361 

3201 

3300 

]  Oval,  biconcave  with- 

6229 

6408 

6300 

J       out  nucleus. 

^,  .  ,           f  Long  diameter 
Chicken     J.  „, 

Short        " 

2102 
3466 

2080 
3483 

2100 
3500 

[  Oval,   with  nucleus. 

^     ,            r  Long  diameter 
^""^^^^^      {short        " 

2045 
3598 

1894 
3444 

2000 
3500 

}      ■• 

(< 

COMPARATIVE   SIZE   OF    BLOOD    CORPUSCLES. 


145 


Comparative  Size  of  Blood  Corpuscles. — (^Continued.) 

(The  figure  is  the  denominator;  the  numerator  is  always  unity.) 


Pigeon 
Quail  . 
Dove  . 
Goose  , 

Duck   . 

Tortoise 
(Land) 

Turtle 
(Green) 

Viper  . 

Frog    . 

Toad    . 

Trout   . 

Perch    . 

Eel   . 
Lamprey 


r  Long  diameter 
i  Short  ' 
f  Long  diameter 
I  Short 

f  Long  diameter 
I  Short       " 
f  Long  diameter 
i  Short       ' 

Long  diameter 

Short       ' 

Long  diameter 

Short       ' 

Long  diameter 

Short       ' 

Long  diameter 

Short       ' 

Long  diameter 

Short       " 

Long  diameter 

Short       " 

Long  diameter 

Short       " 
r  Long  diameter 
1  Short       " 
f  Long  diameter 
1  Short 


nucleus  of 


Observer. 

S  6  S 

> 

1 

0 

Hi 

0 
fa 

1973 

1892 

1900 

3643 

3804 

3700 

2347 

2300 

3470 

3500 

2005 

2000 

3369 

3300 

1836 

1800 

3839 

3800 

1937 

1955 

1900 

3424 

3504 

3500 

1252 

1250 

1200 

2216 

2200 

2200 

I23I 

1200 

1882 

1900 

1274 

1200 

1800 

1800 

1 108 

1089 

IIOO 

I82I 

I80I 

1800 

1043 

1000 

2000 

2000 

1524 

1500 

2460 

2400 

2099 

2100 

2460 

2500 

1745 

1700 

2842 

2800 

2134 

2100 

6400 

6400 

Appearance  of  Cell. 


Oval,  with  nucleus. 


Disk  with  nucleus. 


146  MEDICAL    JURISPRUDENCE. 

III.  The  Optical  or  Spectroscopic  Test. — The  applica- 
tion of  the  spectroscope  to  the  identification  of  blood  depends 
upon  the  fact  that  various  colored  solutions  possess  the 
power  of  absorbing  different  portions  of  the  spectrum,  pro- 
ducing in  the  latter  certain  dark  spaces,  called  absorption- 
bands.  Blood  produces  a  very  decided  effect,  even  in 
minute  quantities. 

When  fresh  hemoglobin  is  examined  by  the  spectroscope, 
it  will  be  seen  to  produce  two  absorption-bands  of  different 
widths  in  the  green.  When  hemoglobin  is  acted  upon  by 
acids  and  alkalies,  or  kept  for  a  long  time,  especially  in  a 
damp  place,  it  acquires  a  brown  color,  becomes  deoxidized, 
and  is  finally  changed  into  hematin.  The  spectrum  of 
deoxidized  hemoglobin,  or  of  venous  blood,  shows  a  single 
broad  absorption-band,  visible  in  the  green.  After  a  short 
exposure  to  the  air  it  gives  a  spectrum  with  the  two  bands 
of  oxidized  hemoglobin  much  weakened,  with  a  third  band 
visible  in  the  red  (methemoglobin).  The  spectrum  of  de- 
oxidized hematin,  or  of  blood  after  prolonged  exposure  to 
air,  shows  two  well-defined  bands  in  the  green,  but  stronger 
than  with  fresh  hemoglobin  and  with  disappearance  of  the 
band  in  the  red. 

Struve's  process  for  the  extraction  of  blood  stains  is 
recommended  by  Klein.  It  consists  in  placing  the  stained 
spot  in  a  test-tube  and  covering  it  with  a  small  quantity  of 
cold  water,  through  which  a  slow  stream  of  carbon  dioxid 
is  made  to  pass.  If  the  stain  is  fresh  (within  a  day),  the 
solution  will  be  complete  in  about  ten  minutes  ;  if  a  month 
old,  about  thirty  minutes  will  be  required  ;  if  two  months 
old,  one  hour's  exposure  may  be  necessary.  The  clear 
solution  thus  obtained  is  to  be  examined  spectroscopically. 
In  the  case  of  very  fresh  stains,  the  two  absorption-bands 


THE    SPECTROSCOPIC    TEST,  1 4/ 

of  oxyhemoglobin  are  alone  visible  ;  but  in  proportion  to 
the  age  of  the  stain,  the  methemoglobin-band  in  the  red 
portion  becomes  more  and  more  decided,  and  in  stains  six 
to  eight  months  old  this  is  the  only  band  visible. 

A  dilute  solution  of  hydrogen  cyanid  (i  to  2  drops  of  a 
I  :  1000  solution)  has  the  effect  of  changing  the  methemo- 
globin-band in  the  red  into  the  two  characteristic  bands 
of  hemoglobin  in  the  yellow  and  green  portions  ;  whilst 
solutions  of  fresh  blood  stains  are  apparently  unchanged. 
Hence  the  action  of  this  reagent  may  possibly  afford  a 
means  of  determinmg  the  age  of  a  given  stain. 

The  form  of  apparatus  best  adapted  for  spectroscopic 
examination  of  blood  is  that  suggested  by  Sorby,  to  whose 
researches  we  are  largely  indebted  for  our  knowledge 
in  this  branch  of  investigation.  It  is  a  combination  of  the 
microscope  and  spectroscope.  The  micro-spectroscope  has 
the  advantage  over  the  ordinary  spectroscope  in  that  a 
comparison  prism  is  inserted,  by  means  of  which  a  fluid  of 
known  composition  may  be  compared  with  the  fluid  under 
investigation,  the  two  spectra  appearing  under  the  micro- 
scope side  by  side.  The  fluid  prepared  for  micro-spectro- 
scopic  examination  is  the  same  as  that  used  for  the 
ordinary  spectroscope,  which  has  been  previously  described. 
By  using  cells  made  from  the  segments  of  barometer  tub- 
ing, a  very  thick  layer  of  blood,  one  inch  in  depth,  may  be 
used  in  the  spectroscope,  when  only  four  or  five  drops  of 
the  suspected  fluid  are  obtainable. 

The  important  question  in  this  connection  is  —  Do  other 
substances  give  similar  spectra  to  those  of  blood  ?  Accord- 
ing to  Sorby,  nothing  gives  a  spectrum  precisely  similar 
to  that  produced  by  oxyhemoglobin,  although  certain  other 
bodies  produce  absorption-lines  somewhat  resembhng  the 


148  MEDICAL    JURISPRUDENCE. 

former,  but  easily  distinguishable  by  a  practiced  observer. 
Thus,  the  coloring  matter  of  the  petals  of  Cineraria  give 
two  absorption-bands  ;  but  they  are  easily  distinguished  by 
the  action  of  ammonium  hydroxid.  Cochineal,  madder, 
and  other  red  dyes,  dissolved  in  alum,  although  affording 
bands  somewhat  resembling  those  produced  by  blood,  may 
be  distinguished  from  the  latter  by  the  use  of  ammonium 
hydroxid  and  potassium  sulphite. 

We  must,  therefore,  admit  that  the  spectroscope  affords 
a  valuable  and  deHcate  test  for  the  presence  of  blood.  It 
cannot,  however,  discriminate  between  human  blood  and 
that  of  any  of  the  lower  animals ;  in  this  respect,  therefore, 
it  is  inferior  to  the  microscope,  as  a  test. 

BURNS  AND  SCALDS. 

A  burn  is  an  injury  to  the  body,  caused  by  heat  applied 
either  in  the  form  of  a  heated  solid  substance,  or  by  flame, 
or  by  radiant  heat. 

A  scald  is  an  injury  produced  by  a  heated  liquid  applied 
to  the  body. 

Burns  and  scalds  are  not,  strictly  speaking,  wounds ; 
though  legally  they  are  comprised  under  the  term,  bodily 
injuries.  The  effects  of  corrosive  liquids,  such  as  sulphuric 
and  other  mineral  acids,  and  the  strong  alkalies,  closely 
resemble  burns,  and  they  are  so  regarded  in  law.  Boiling 
liquids  taken  internally  may  produce  internal  scalds. 

The  intensity  of  a  burn  is  dependent  upon  the  degree  of 
heat  applied  :  it  varies  from  a  slight  redness  to  a  complete 
charring  of  the  tissues,  Metals  heated  to  redness  produce 
very  severe  burns,  even  to  the  destruction  of  the  flesh  ;  but 
if  in  a  state  of  fusion,  the  injury  is  yet  more  serious,  in  con- 
sequence of  the  partial  adhesion  of  the  molten  mass  to  the 


DID  THE  BURN  OCCUR  BEFORE  OR  AFTER  DEATH?  1 49 

skin.  Boiling  oils  produce  as  decided  effects  as  hot  solids 
or  molten  metals.  Boiling  water  causes  scalds,  more  or  less 
severe,  attended  with  vesications  containing  serum  ;  but  it 
never  chars  or  destroys  the  tissue. 

According  to  Dupuytren,  burns  may  be  classified  as  fol- 
lows, according  to  their  degree  or  extent : 

1.  Superficial  inflammation  of  the  skin,  without  vesi- 
cation. 

2.  Vesication,  or  blisters,  containing  serum,  sometimes 
clear,  and  sometimes  opaque  and  bloody.  If  the  cuticle  be 
removed,  the  true  skin  is  very  red  and  granulated,  and 
secretes  pus. 

3.  Destruction  of  the  external  surface  of  the  true  skin, 
forming  an  eschar,  which  may  be  soft  and  yellow  if  made 
by  a  liquid,  or  hard  and  brown  or  black,  if  resulting  from 
a  solid.  The  surrounding  skin  is  red  and  blistered.  This 
form  of  burns  leaves  ugly  cicatrices,  which  are  white  and 
shining. 

4.  Disorganization  of  the  whole  skin ;  these  differ  from 
the  last  only  in  the  deeper  destruction  of  the  parts,  and  in 
the  thickness  of  the  sloughs.  The  resulting  scars  are 
puckered,  and  depressed  below  the  level  of  the  skin. 

5.  The  destruction  here  extends  through  the  skin,  and 
includes  the  cellular  tissue  and  a  portion  of  the  muscles. 
The  general  character  is  the  same  as  in  4. 

6.  Complete  carbonization  of  the  burnt  part,  as  when  a 
portion  of  the  body  is  roasted  by  the  fire. 

The  important  medico-legal  question  to  determine  is  — 
Was  the  burn  upon  the  body  made  before  or  after  death  ? 
It  is  evident  that  an  assassin  might  murder  his  victim,  and 
then  set  fire  to  the  house,  hoping  thus  to  escape  detection. 
If  a  body  be  found  completely  charred,  it  will  be  impossible 


150  MEDICAL    JURISPRUDENCE. 

to  determine  whether  it  was  living  or  dead  when  acted  upon 
by  the  heat ;  but  if  the  burn  be  less  extensive,  it  may  be 
possible  to  form  an  opinion. 

As  regards  vesications  which  result  from  moderately 
heated  solids,  or  from  scalding  liquids,  if  they  contain  serum 
their  presence,  as  a  rule,  indicates  that  the  burn  was  in- 
flicted during  life.  The  experiments  of  Christison  Taylor, 
and  Tidy  go  to  show  that,  although  the  application  of  heat 
to  a  body  within  a  few  minutes  after  death  may  sometimes 
produce  a  blister,  this,  however,  does  not  contain  serum, 
but  only  gas  ;  serous  exudation  must  be  regarded  as  vital. 
There  may  be  an  exception  to  the  above  rule  in  the  case  of 
dropsical  subjects,  in  whom  it  is  stated  on  good  authority 
that  serous  blisters  may  be  produced  after  death,  by  the 
application  of  heat.  But,  on  the  other  hand,  the  absence  of 
vesication  should  not  be  regarded  as  a  proof  that  the  burn 
was  not  inflicted  during  life,  since  vesication  is  not  always  a 
necessary  result  of  a  burn  ;  besides,  it  is  quite  possible  that 
only  the  more  serious  results  may  be  visible.  It  is  recom- 
mended, in  all  doubtful  cases,  to  examine  the  cuticle  mi- 
nutely, with  a  lens,  for  minute  apertures  through  which  the 
serum  may  have  escaped. 

Another  sign  of  burning  during  life  is  the  presence  of  a 
red  line  around  the  burn,  which  gradually  merges  into  the 
color  of  the  surrounding  skin.  This  red  border  remains 
after  death,  and  cannot  be  produced,  according  to  Christison 
and  Taylor,  by  the  application  of  heat  to  the  dead  body. 
Tidy's  conclusions,  based  upon  a  series  of  his  own  experi- 
ments, are  that  "  when  serous  blisters  are  seen  on  a  dead 
body,  the  serum  being  thick  and  rich  in  albumin,  and  the 
blisters  surrounded  by  a  deeply  injected  red  line,  the  true 
skin,  after  the   removal   of  the   cuticle,  also  presenting  a 


DID  THE  BURN  OCCUR  BEFORE  OR  AFTER  DEATH  ?       I  5  I 

reddened  appearance,  the  evidence  is  strong  that  the  burn 
was  produced  during  the  life  of  the  person  ;  while  it  is  con- 
clusive that  it  was  caused  during  the  life  of  the  part.  But 
if  the  blister  contains  air,  the  true  skin,  after  the  removal  of 
the  cuticle,  appearing  dry  and  unglazed,  of  a  full  white 
color,  or  grayish  ;  or,  if  the  bhster  contained  a  Httle  thin, 
non-albuminous  serum,  there  being  in  neither  case  any  red 
surrounding  line,  nor  any  injected  condition  of  the  cutis 
vera,  the  evidence  is  strong  that  the  burn  was  inflicted 
after  death." 

The  danger  of  burns  depends  more  on  their  extent  than 
their  depth.  The  reason  of  this  is  that  extensive  burns 
involve  a  greater  number  of  sensory  nerves,  and  a  greater 
extent  of  surface  is  prevented  from  performing  the  function 
of  excretion  and  heat  regulation.  Thus,  a  large  superficial 
scald,  especially  in  young  children,  is  very  apt  to  prove 
fatal,  the  symptoms  being  stupor,  somnolence,  pallor  of 
face,  and  feeble  pulse,  with  slow  and  stertorous  breathing  — 
very  similar  to  those  of  narcotic  poisoning,  for  which,  in- 
deed, they  have  sometimes  been  mistaken.  It  has  been 
ascertained  that  if  one  half  to  two  thirds  of  the  entire  skin 
be  involved,  the  burn  will  certainly  prove  fatal ;  but  practi- 
cally, one  involving  one  third  of  the  body,  if  severe,  would 
be  very  likely  to  cause  death.  But  here,  many  circum- 
stances will  have  to  be  considered,  such  as  the  age,  consti- 
tution, the  part  affected,  and  the  character  of  the  burn. 
Burns  are  more  dangerous  in  the  young ;  more  so  on  the 
trunk  of  the  body  than  on  the  limbs  ;  and  more  so  if  in 
separate  patches  than  if  continuous,  provided  they  are  of 
equal  extent.  Gunpowder  burns  are  considered  more  dan- 
gerous than  those  produced  by  steam. 

The  Causes    of   Death  from    burns  are  various:  as  (i)'Y 


152  MEDICAL   JURISPRUDENCE. 

bodily  injury ;  as  in  the  case  of  conflagrations  of  buildings, 
where  instantaneous  death  may  result  from  the  fall  of  tim- 
bers, walls,  etc.,  or  from  leaping  out  of  a  window,  or  from 
a  roof.  (2)  Suffocation,  either  from  the  smoke,  or  from  the 
want  of  air.  (3)  Shock  ;  this  is  probably  the  most  frequent 
cause  of  death  after  extensive  burns.  (4)  Coma,  convul- 
sions, or  tetanus.  (5)  Bronchitis,  pneumonia,  and  other 
thoracic  symptoms.  (6)  Enteritis  and  peritonitis.  (7) 
Exhaustion.     (8)  Gangrene,  pyemia,  etc. 

Post-mortem  Appearances. — These  are  often  not  well 
marked,  the  most  constant  lesions  being  a  capillary  injec- 
tion of  the  mucous  membrane  of  the  alimentary  canal  and 
bronchi,  and  serous  effusion  into  the  ventricles  of  the  brain. 
In  cases  where  the  death  has  occurred  from  injury,  or  from 
suffocation,  the  usual  lesions  would,  of  course,  be  discov- 
ered after  death ;  but  if  the  body  has  been  completely 
charred  or  roasted,  it  will  probably  be  impossible  to  distin- 
guish anything  to  enable  us  to  form  an  opinion  as  to  whether 
the  death  had  preceded  the  burning  or  not.  The  means  of 
identifying  the  charred  remains  of  a  burnt  body  have  already 
been  pointed  out. 

Wounds  upon  the  Burned.  —  From  the  fact  that  murder 
is  frequently  committed  and  the  body  subsequently  burned 
by  a  criminal,  with  a  view  of  destroying  the  traces  of  his 
crime,  it  is  important  for  the  legal  physician  always  to  ex- 
amine the  body  for  wounds.  There  are  certain  mechanical 
effects  produced  upon  the  body  by  fire  which  might  possi- 
bly be  mistaken  for  wounds  made  before  death,  such  as 
fissure  in  the  thorax  or  abdomen,  or  in  the  neighborhood 
of  the  large  joints.  These  fissures  are  generally  irregular 
in  form  ;  and  as  the  blood-vessels,  by  their  elasticity,  are  apt 


WOUNDS    UPON    THE    BURNED.  1 53 

to  escape  being  torn,  these  may  be  seen  intact,  stretching 
across  the  fissure.  This  appearance  is  always  indicative 
that  the  opening  was  caused  by  heat,  and  was  not  a  real 
wound,  A  case  is  mentioned  in  which  two  old  persons  were 
found  burned  in  their  house  ;  the  fact  of  their  having  been 
previously  stunned,  if  not  killed,  by  blows  on  the  head,  was 
ascertained  by  the  existence  of  fractures  of  the  skull,  under 
which  coagulated  blood  was  found  upon  the  dura  mater. 
Where  the  heat  has  been  excessive,  the  bones  of  the  de- 
ceased may  be  found  more  or  less  cracked  or  split,  and 
sometimes  even  crumbled  to  pieces.  Ordinary  incised, 
punctured,  or  contused  wounds,  made  before  death,  could 
not  be  identified  in  a  body  completely  charred  by  fire. 

As  to  the  question  of  the  burning  being  accidental,  sui- 
cidal, or  homicidal,  it  may  be  assumed  that  death  by  burn- 
ing is  nearly  always  accidental ;  and  such  cases  are,  unfor- 
tunately, of  frequent  occurrence.  Death,  in  such  accidental 
instances,  mostly  occurs  at  some  distance  from  the  fire,  in 
consequence  of  the  removal  of  the  injured  person  ;  although 
of  course  it  may  take  place  at  the  time  and  place  of  the 
conflagration.  The  fact  that  a  dead  body  is  found  near  the 
fire  may  veiy  naturally  suggest  the  idea  of  accident,  since 
an  intoxicated  or  a  diseased  person  may  have  caught  fire 
and  been  unable  to  move.  In  all  such  cases,  it  is  important 
to  examine  the  body  for  marks  of  violence,  with  the  pre- 
cautions given  above.  Furthermore,  a  case  might  present 
itself  where  severe  wounds  were  found  on  a  burnt  body, 
and  the  question  might  arise  whether  the  wounds  or  the 
fire  had  been  the  cause  of  death.  No  general  rules  can  be 
given  for  guidance  in  such  cases  ;  each  one  must  be  deter- 
mined by  the  attending  circumstances. 

The  question  of  Spontaneous  Combustion  of  the  human 
13 


154  MEDICAL    JURISPRUDENCE. 

body  presents  itself  here  for  a  brief  notice.  It  has  occa- 
sioned considerable  discussion  in  the  scientific  world  for 
many  years  past ;  but  although  some  remarkable  instances 
are  related  of  apparent  spontaneous  combustion  of  the 
human  body,  originating  while  alive,  on  close  investigation 
it  will  be  found  that  some  source  of  fire  had  invariably  been 
present,  from  which  the  combustion  took  its  origin,  such  as 
a  lighted  pipe  or  candle,  and  that  the  body  was  that  of  a 
habitual  spirit-drinker,  and  nearly  always  that  of  a  very  fat 
person,  conditions  highly  favorable  for  the  process  of  com- 
bustion when  once  originated. 

From  the  known  composition  of  the  human  body — nearly 
75  per  cent,  being  water — it  would  seem  to  be  impossible 
even  to  burn  it  up,  except  by  the  application  of  a  high 
degree  of  heat,  and  for  a  long  time,  such  as  is  required  by 
the  process  of  cremation.  Certainly,  the  weight  of  authority 
is  against  the  belief  in  spontaneous  combustion  of  the 
human  body ;  no  person  of  position  or  authority  has  ever 
witnessed  such  a  phenomenon. 

It  is,  of  course,  an  admitted  fact  that  various  organic  and 
mineral  substances  undergo  rapid  combustion,  through  the 
action  of  oxygen,  especially  when  exposed  to  the  action  of 
the  air,  in  a  state  of  fine  powder  or  extended  surface,  as  in 
flour-mills  and  other  places  where  much  fine  dust  is  evolved. 
Conflagrations  of  large  buildings  have  frequently  thus  orig- 
inated, involving  important  questions  as  to  incendiarism  and 
fire  insurance. 

DEATH  FROM  DIFFERENT  FORMS  OF  APNEA  (ASPHYXIA). 
This    includes    death    from    Suffocation,    Strangulation, 
Hanging,  and  Drowning,  in  all  of  which  life  is  destroyed 
chiefly,   is    not    exclusively,   by   apnea    or    asphyxia.     All 


VIOLENT  DEATH  FROM  APNEA.  155 

these  modes  of  violent  death  possess  certain  points  in  com- 
mon, while,  at  the  same  time,  each  of  them  is  distinguished 
by  individual  peculiarities,  which  render  a  separate  consid- 
eration desirable.  Their  common  properties  will  be  first 
briefly  considered. 

In  all  cases  of  apnea,  death  begins  in  the  lungs,  and  this 
is  brought  about  simply  by  excluding  the  air  from  these 
organs.  This  is  brought  about  in  various  ways :  mechanical 
pressure  upon  the  throat  or  thorax,  as  in  throttling;  by 
ligature  around  the  throat,  as  in  hanging  and  strangling; 
by  the  flow  of  water  into  the  windpipe,  as  in  drowning ;  by 
foreign  bodies  getting  into  the  larynx  and  trachea,  as  in 
choking ;  by  being  shut  up  in  a  box,  entombed  alive,  or 
buried  under  ruins,  or  in  a  sand  bank,  or  snow  drift ;  or  by 
some  disease  of  the  throat,  as  edema  and  spasm  of  the 
glottis,  membranous  croup,  etc.  ;  —  all  of  which  produce 
death  by  simply  arresting  the  function  of  respiration. 

Likewise,  there  are  exhibited  certain  signs  or  phenomena, 
both  before  and  after  death,  which  indicate  death  by  apnea.   ' 
These  are  lividity  of  the  lips,  fingers,  and  other  extremities, 
and  generally  of  the  whole  face,  together  with  a  swollen 
appearance  of  the  countenance ;    convulsive  movements  of 
the   arms    and    legs,   at  'first   partly  voluntaiy,   but    soon 
becoming    spasmodic    and    involuntary,    as    seen    in    the    f-  u 
struggles  to  breathe ;    the  veins  become  turgid  ;  the  pulse, 
at  first  full  and  rapid,  soon  becomes  feeble ;   there  is  often 
frothing  at  the  mouth,  which  may,  at  times,  be  tinged  with 
blood  from  wounding  of  the  tongue  ;   there  is   frequently 
turgescence    of  the    genital    organs,   and    involuntaiy  dis- 
charges of  semen,  urine,  and  feces.     Abortive  attempts  at 
respiration  are  made  for  a  while,  but  finally  these  cease,  and  , 
the  heart  at  last  ceases  to  pulsate. 


156  MEDICAL   JURISPRUDENCE. 

Consciousness  is  lost  veiy  early,  although  in  the  earliest 
stage  there  may  be  remarkable  activity  of  the  senses.  This 
stage  lasts  only  for  a  veiy  brief  time  ;  such  is  the  testimony 
of  persons  who  have  been  rescued  from  drowning,  or  who 
have  been  cut  down  from  hanging,  and  of  those  who  have 
experimented  upon  themselves  by  partial  strangulation. 

This  kind  of  death  is  rapid,  not  requiring  more  than 
three  to  five  minutes,  though  there  are  some  apparent 
exceptions  in  the  case  of  drowning.  These  will  be  referred 
to  hereafter. 

The  post-mortem  appearances  in  all  these  varieties  of 
death  by  apnea  are,  in  the  main,  very  similar.  These  are 
lividity  of  the  lips,  fingers,  and  other  parts  of  the  body,  as 
seen  before  death ;  in  drowning,  the  face  is  apt  to  be  pale  ; 
sometimes,  likewise,  in  hanging.  The  venous  system  is 
generally  full  of  blood.  The  right  side  of  the  heart, 
together  with  the  lungs,  is  usually  gorged  with  dark  blood  ; 
if  death  has  been  rapid,  post-mortem  clots  will  be  found  in 
the  heart  cavities  ;  if  it  has  been  slow,  ante-mortem  or  white 
clots  may  be  found  ;  the  mucous  membrane  of  the  bronchial 
tubes  deeply  congested.  In  young  persons,  the  blood- 
vessels of  the  lungs  will  often  be  found  empty,  and  the 
lungs  emphysematous,  from  the  violent  efforts  made  to 
respire.  Minute  extravasations  of  blood  (ecchymoses)  are 
found  in  the  mucous  and  serous  membranes,  as  the  pleura, 
pericardium,  endocardium,  peritoneum,  etc.  The  veins  and 
sinuses  of  the  brain  are  usually  turgid  with  blood,  and  the 
brain  itself  filled  with  bloody  points.  The  solid  viscera,  as 
the  liver,  spleen,  and  kidneys,  will  generally  be  congested. 
The  blood  itself  is  mostly  fluid  and  dark-colored,  except 
in  suffocation  from  carbon  monoxid,  when  its  color  is 
bricrht  red. 


SUFFOCATION.  1 57 

Suffocation,  properly  speaking,  includes  every  variety 
of  death  resulting  from  an  impediment  to  respiration.  But 
as  Strangulation,  Hanging,  and  Drowning  are  considered 
separately,  the  term  is  here  restricted  to  the  other  modes 
of  death  by  apnea. 

Cases  of  accidental  suffocation  are  numerous.  Infants 
have  thus  perished  by  being  too  closely  wrapped  up,  or  by 
being  overlaid  by  their  mothers.  Young  children,  feeble 
persons,  epileptics,  and  drunkards,  have  been  suffocated  by 
falling  into  ashes,  soft  mud,  feathers,  and  similar  articles, 
from  which  they  have  been  unable  to  extricate  themselves. 
Mechanical  pressure  on  the  thorax,  as  occurs  in  vast 
crowds  of  people,  has  destroyed  life  by  suffocation.  The 
accidental  slipping  into  the  larynx  of  small  bodies,  such  as 
peas,  grains  of  corn,  marbles,  etc.,  from  the  mouth,  particu- 
larly in  children  ;  the  lodgment  of  a  piece  of  meat  in  the 
air  passages  (choking) ;  the  detachment  of  a  bronchial 
gland  which  becomes  impacted  in  the  larynx ;  the  escape 
of  a  lumbricus  from  the  stomach,  and  its  entering  the 
larynx ;  the  passing  of  vomited  matters  and  of  blood  into 
the  windpipe  ;  various  disorders  of  the  throat,  as  edema 
and  spasm  of  the  glottis,  croup,  diphtheria,  abscess,  etc.;  — 
all  of  these  are  examples  of  accidental  suffocation. 

Suicidal  suffocation  is  extremely  rare,  though  a  few 
remarkable  cases  are  mentioned  by  authors.  In  one  case  — 
that  of  a  young  woman — death  was  caused  by  a  ball  of 
hay,  which  she  had  thrust  down  the  throat  in  the  pharynx, 
behind  the  larynx,  and  which  was  just  visible  when  the 
mouth  was  widely  opened. 

Homicidal  suffocation  is  usually  practised  upon  infants, 
the  aged,  or  those  who  are  otherwise  helpless.  Suffocation 
is  undoubtedly  a  very  common  mode  of  destroying  new- 


158  MEDICAL   JURISPRUDENCE. 

born  children  ;  it  is  very  easily  effected,  and  may  leave  be- 
hind it  no  characteristic  traces  ;  death,  in  such  cases,  being 
usually  attributed  to  convulsions.  The  notorious  Edin- 
burgh murderers,  Burke  and  Hare,  destroyed  their  victims 
by  suffocation,  forcibly  closing  the  mouth  and  nostrils  of 
the  person,  and  at  the  same  time  bearing  their  whole 
weight  upon  the  breast.  A  curious  Scotch  case  is  recorded, 
in  which  an  intemperate  woman,  over  sixty  years  of  age,  was 
found  dead,  with  a  wound  upon  the  scalp,  emphysema  in 
the  chest,  and  seven  ribs  fractured.  The  face  was  pale  and 
composed,  the  eyes  closed,  and  the  tongue  slightly  pro- 
truding. On  examination,  the  cork  of  a  quart  bottle  was 
found  in  her  larynx,  the  sealed  end  being  uppermost.  The 
epiglottis,  trachea,  and  larynx  were  considerably  injected. 
It  was  attempted,  on  the  trial,  to  show  that  the  deceased 
had  drawn  out  the  cork  with  her  teeth  while  she  was 
drunk,  but  that  it  was  suddenly  forced  into  her  windpipe  ; 
this  was  negatived  by  the  fact  that  the  sealed  end  of  the 
cork  was  uppermost,  and  also  by  the  marks  of  the  cork- 
screw. It  was  decided  that  the  cork  had  been  forcibly 
pushed  into  her  windpipe,  when  by  reason  of  intoxication 
she  was  unable  to  resist.  Another  case  of  homicidal 
suffocation  is  that  of  a  Russian  sentry,  found  dead  in  his 
watch-box,  with  a  large  piece  of  meat  in  the  lower  part 
of  the  pharynx,  pressing  upon  and  partly  in  the  glottis. 
His  death  was,  therefore,  supposed  to  be  accidental.  Some 
years  after,  his  superior  officer,  in  dying,  confessed  that 
he  had  first  suffocated  the  man,  and  then  placed  the  piece 
of  meat  in  his  throat,  in  order  to  divert  suspicion  from 
himself 

Post-mortem  Appearances.— ~\l\\^\\.y  and  swelling  of  the 
face  and  lips  are  usual,  but  in  accidental  cases  the  face  may 


ASPHYXIA   FROM    CHArCOAL   VAPOR,  I  59 

be  placid ;  the  eyes  are  congested ;  minute  ecchymoses 
appear  on  the  neck  and  chest ;  with  mucous  froth,  some- 
times bloody,  about  the  mouth  and  nose  ;  the  lungs  and 
right  side  of  the  heart  may  be  gorged  with  dark  blood  ;  but 
in  some  cases,  especially  in  young  children,  the  lungs  may 
be  empty  of  blood  and  emphysematous.  Hence,  the  con- 
dition of  the  lungs  and  heart,  as  it  varies  so  much,  cannot 
be  relied  on  in  a  diagnosis.  Stress  has  been  laid  upon  the 
presence  of  minute  punctiform  ecchymoses,  especially  en 
the  lungs  of  new-born  infants  who  have  been  suffocated. 
These  spots  are  also  found  on  the  pleura,  lining  membrane 
of  the  heart,  membranes  of  the  brain,  peritoneum,  and 
mucous  lining  of  the  windpipe,  but  their  value  is  not  uni- 
versally acknowledged.  The  blood  is  dark  and  very  fluid. 
The  kidneys  are  deeply  congested. 

As  these  post-mortem  signs  are  also  found  in  other 
forms  of  death  by  apnea,  they  cannot  be  considered  as 
characteristic  of  death  by  suffocation.  Consequently,  the 
examiner  should  be  cautious  in  expressing  his  opinion  as 
to  the  cause  of  death.  If  a  dead  body  be  discovered  in 
sand,  earth,  ashes,  or  similar  substances,  the  question 
whether  it  was  placed  there  before  or  after  death  must  be 
decided  by  a  careful  examination.  If  the  substances  be 
found  in  the  air  passages,  and  especially  in  the  esophagus 
and  stomach,  it  may  be  concluded  that  the  person  was 
alive  at  the  time. 

Asphyxia  from  Gas  from  Charcoal. — The  gases  evolved 
by  burning  charcoal  consist  of  carbon  dioxid  and  carbon 
monoxid  ;  the  relative  proportion  of  them  will  depend  on 
the  air-supply.  If  this  be  abundant,  the  former  gas  will  be 
considerably  in  excess ;  if  imperfect,  the  latter  gas  will  be 


l60  MEDICAL   JURISPRUDENCE. 

in  greater  quantity.  Charcoal  burning  in  the  open  air  pro- 
duces but  a  small  amount  of  monoxid.  An  atmosphere 
containing  5  per  cent,  of  carbon  dioxid  and  ^  per  cent, 
of  monoxid  has  been  said  to  be  fatal  to  man.  There  is, 
however,  some  uncertainty  as  to  the  limit  at  which  carbon 
dioxid  is  fatal. 

Symptoms  and  Post-mortem  Appearances. — Headache,  with 
a  sense  of  pressure  on  the  temples,  vertigo,  ringing  in  the 
ears,  and  tendency  to  sleep,  complete  loss  of  muscular 
power,  troubled  vision,  difficulty  of  breathing,  rapid  and 
feeble  pulse,  sometimes  vomiting,  coma,  and  death,  occa- 
sionally preceded  by  convulsions.  Death  takes  place  in 
from  one  to  two  hours  after  exposure  ;  and  experience 
shows  that  this  may  occur  even  when  the  external  air  is 
not  completely  excluded. 

The  post-mortem  lesions  vary,  depending  upon  the  rapidity 
of  the  asphyxia,  and  the  time  elapsed  between  the  death  and 
the  autopsy.  Sometimes  the  face  is  injected,  the  eyes  bright 
and  staring,  and  the  limbs  supple ;  again,  there  is  a  general 
pallor  of  the  surface  and  complete  rigidity  of  the  muscles, 
coming  on  very  soon  after  death,  and  disappearing  in  a  few 
hours.  According  to  Lutaud,  the  most  characteristic  sign 
is  the  presence  of  large  rosy-colored  spots,  more  or  less  pro- 
nounced, over  the  thighs,  chest,  and  abdomen.  "These  rose- 
colored  spots  are  not  seen  in  any  other  variety  of  asphyxia 
and  they  remain  even  after  the  commencement  of  putrefac- 
tion." The  apoplectic  nodules  in  the  lungs,  and  the  sub- 
pleural  ecchymoses,  so  common  in  strangulation  and  suffo- 
cation, are  rarely  seen.  There  is  more  or  less  congestion 
of  the  brain.  Another  important  sign  is  the  fluidity  and 
bright  redness  of  the  blood.  This  is  owing  to  the  stronger 
affinity  of  the  hemoglobin  for  carbon  monoxid  than  for  oxy- 


ASPHYXIA    FROM    CHARCOAL    VAPOR.  l6l 

gen,  in  consequence  of  which  the  former  is  retained  through- 
out the  circulation.  The  spectrum  furnished  by  such  blood 
very  closely  resembles  that  shown  by  arterial  blood  in  the 
spectroscope.  This  affinity  of  the  hemoglobin  for  carbon 
monoxid  will  satisfactorily  explain  the  presence  of  the  rose- 
colored  spots  above  alluded  to. 

In  case  of  death  from  gases  from  charcoal,  spectroscopic 
examination  of  the  blood  should  be  made.  By  this  means, 
Brouardel  was  enabled  to  demonstrate  the  existence  of 
carbon  monoxid  in  the  blood  of  one  of  the  victims  of  the 
burning  of  the  Hospital  of  Saint-Antoine,  in  1887.  The 
absorption-lines  of  carboxy- hemoglobin,  that  is,  blood  con- 
taining carbon  monoxid,  are  so  similar  to  those  of  ordinary 
(oxy)  hemoglobin  that  distinction  by  observation  alone  is 
difficult.  The  two  spectra  may  be  at  once  distinguished 
by  the  fact  that  the  addition  of  a  reducing  agent,  such  as  a 
drop  or  two  of  ammonium  sulphid  to  the  blood,  will  pro- 
duce at  once  a  reduced  hemoglobin  in  the  case  of  normal 
blood  and  change  the  spectrum,  while  that  of  carboxy- 
hemoglobin  will  not  be  affected.  The  extensive  introduc- 
tion of  water-gas  for  illuminating  and  heating  purposes  has 
caused  a  material  increase  of  cases  of  carbon  monoxid 
poisoning  in  American  cities.  This  gas,  made  by  the 
action  of  steam  upon  hot  fuel,  consists  largely  of  carbon 
monoxid.  Illuminating  gas  made  by  the  distillation  of 
bituminous  coal  consists  mostly  of  hydrocarbons,  and  is 
far  less  poisonous.  The  cases  of  asphyxia  produced  by 
carbon  monoxid  are  not  readily  amenable  to  artificial  respi- 
ration, since  the  chemical  affinity  of  the  gas  for  the  hemo- 
globin is  not  overcome  by  the  oxygen. 

Slowness    of   putrefaction  is    often    noticed    in   cases  of 
death  from  this  form  of  asphyxia. 
14 


1 62  MEDICAL    JURISPRUDENCE. 

Various  chemical  tests  for  carboxy-hemoglobin  have  been 
proposed,  but  they  are  of  little  value.  The  spectroscopic 
test  seems  to  be  the  best,  but  even  in  undoubted  cases  of 
poisoning,  as  where  the  gas  has  been  directly  inhaled  with 
suicidal  intent,  the  results  of  the  examination  will  sometimes 
be  unsatisfactory. 

It  may  be  well  to  remember  that  the  body  of  a  murdered 
person  may  have  been  so  disposed  of  by  an  assassin,  as  to 
simulate  death  from  charcoal  asphyxia ;  of  course  all  the 
signs  of  any  such  antecedent  violence  should  be  carefully 
sought. 

When  illuminating  gas  forms  about  one  eleventh  of  the 
atmosphere,  it  becomes  explosive  on  contact  with  a  flame. 
It  requires,  however,  a  less  proportion  than  this  to  render 
the  air  incapable  of  supporting  life.  The  so-called  "  sewer- 
gas  "  explosions  are  due  to  the  leakage  of  illuminating  gas 
into  sewers  and  drains.  The  gases  evolved  from  sewage 
do  not  possess  the  power  of  forming  explosive  mixtures. 

Many  instances  of  sickness  and  death  may  be  due  to  the 
unconscious  breathing  of  deleterious  vapors  arising  from 
leakage  of  gas-pipes,  and  escapes  of  the  gas  into  the  apart- 
ments. 

The  introduction  of  acetylene  as  an  illuminating  and 
heating  agent  will  doubtless  give  rise  to  cases  of  fatal 
poisoning,  but  there  are  no  data  yet  at  hand  to  permit  a 
satisfactory  presentation  of  the  medico-legal  relations. 

Asphyxia  from  Emanations  of  Cesspools.  —  These 
contain  hydrogen  sulphid  and  ammonium  sulphid,  together 
with  other  sulphur  compounds  of  unknown  composition. 

The  symptoms  are  a  sense  of  fullness  and  pain  in  the  head 
and  stomach,    vertigo,    nausea,    sudden   loss   of  muscular 


DEATH    BY    STRANGULATION.  1 63 

power  and  of  consciousness.  There  is  often  an  escape  of 
bloody  froth  from  the  mouth.  The  body  is  cold,  the  face 
livid,  the  pupils  dilated  and  immovable  ;  convulsions  and 
coma  usually  precede  death. 

In  the  examination  of  cases  of  asphyxia  from  the  emana- 
tions of  cesspools  or  sewers,  the  expert  should  seek  to 
isolate  the  toxic  agent  (hydrogen  sulphid)  from  the  blood. 

Strangulation  is  produced  either  by  pressure  upon  the 
neck  by  means  of  an  encircling  cord,  or  by  direct  pressure 
made  by  the  hand  on  the  windpipe,  as  in  throttling.  The 
means  by  which  the  constriction  is  produced  are  various  : 
sometimes  a  rope  is  used,  sometimes  a  strap,  a  handkerchief, 
a  ribbon,  or  a  strip  torn  from  a  sheet  or  the  clothing.  In 
Spain,  the  usual  mode  of  execution  of  criminals  is  by  the 
garrote  —  a  steel  collar  tightened  by  a  screw ;  in  Turkey  it 
is  by  a  bow  string.  Death  results,  in  most  cases,  from 
the  combined  effect  of  the  deprivation  of  atmospheric  air, 
producing  apnea,  and  from  congestion  of  the  brain  due  to 
the  pressure  upon  the  jugulars,  preventing  a  return  of  blood 
from  the  brain.  Sudden  and  violent  compression  by  the 
hand  upon  the  windpipe  will  produce  unconsciousness 
sooner  than  if  the  constriction  be  made  by  a  band.  Stran- 
gulation differs  from  hanging  chiefly  in  the  obliquity  of  the 
cord  around  the  neck  in  the  latter,  while  in  strangulation 
the  cord  is  wound  horizontally  around  the  neck.  It  is  im- 
portant to  distinguish  between  death  from  strangulation 
and  death  from  hanging,  as  the  former  is  nearly  always  the 
result  of  homicide,  while  the  latter  is  usually  suicide.  The 
first  question  that  presents  itself  is  :  Was  the  death  caused 
by  strangulation  ?  The  appearances  of  one  strangled  are 
usually  very  distinctly  marked  :  These  are  livid  and  swollen 


164  MEDICAL   JURISPRUDENCE. 

face ;  staring  eyes,  with  dilated  pupils  and  protruding 
tongue,  which  may  be  bitten  ;  livid  extremities  ;  flattened 
larynx ;  blood  may  issue  from  the  nose,  mouth,  or  even 
ears ;  the  face,  neck,  chest,  and  eyes  are  studded  with 
ecchymoses  ;  the  genital  organs  are  frequently  turgid  ;  and 
there  may  be  an  escape  of  urine  and  feces,  as  in  hanging. 
Internally,  the  right  heart  and  venous  system  are  some- 
times gorged  with  blood ;  but  this  is  less  frequent  than  in 
other  forms  of  death  from  apnea  ;  this  is  also  true  of  the 
congestion  of  the  liver  and  kidneys.  Tardieu  states  that 
the  lungs  are  seldom  veiy  full  of  blood,  but  he  places  great 
reliance  upon  the  emphysematous  appearance  of  these 
organs,  arising  from  a  rupture  of  the  pulmonary  vesicles. 
The  subpleural  ecchymoses,  which  he  regards  as  charac- 
teristic of  suffocation,  he  says,  are  rare  in  strangulation. 
There  are  also  extravasations  of  blood  in  the  lungs,  but 
none  in  the  brain,  whereby  it  is  distinguished  from  apo- 
plexy, which  it  resembles  in  a  few  of  its  symptoms. 

Among  the  external  signs,  the  marks  of  the  cord,  and  of 
the  fingers  on  the  neck,  deserve  special  attention.  These 
are  more  evident  and  reliable  here  than  in  hanging,  because 
in  homicidal  strangulation  very  considerable  force  is  gener- 
ally employed  by  the  murderer  in  order  to  accomplish  his 
object.  If  the  hand  has  been  used,  as  in  throttling,  the 
marks  of  the  fingers  will  be  found  upon  the  front  of  the 
throat — sometimes  of  two  or  more  fingers  and  the  thumb, 
so  that  even  the  particular  hand  employed  may  be  deter- 
mined. If  a  cord  has  been  used  the  mark  will  be  horizontal, 
not  oblique,  as  in  hanging  ;  sometimes  there  may  be  two 
or  three  parallel  marks,  where  the  cord  has  been  wound 
around  the  neck  several  times.  The  mark  of  the  cord  is 
apt  to  be  less  deep  than  in  hanging,  and  subcutaneous  ex- 


ACCIDENTAL   STRANGULATION.  165 

travasation  is  not  always  found  ;  but  the  parts  beneath  may 
show  considerable  infiltration  of  blood.  Fractures  of  the 
hyoid  bone  and  of  the  ossified  thyroid  cartilage  are  reported 
as  having  occurred.  Where  great  violence  has  been  used 
to  the  neck,  blood  may  escape  from  the  mouth  and  nose. 
The  interior  of  the  larynx  and  trachea  is  congested,  of  a 
uniform  red  or  violet  color,  and  is  coated  over  with  a 
frothy,  bloody  mucus,  which  extends  also  into  the  smaller 
air  tubes.  This  internal  discoloration  of  the  windpipe 
should  not  be  mistaken  for  the  early  signs  of  putrefaction 
of  this  organ. 

The  mark  of  the  cord  around  the  neck  may  unquestion- 
ably be  produced  on  the  dead  body,  if  the  attempt  is  made 
within  a  few  hours  after  death,  and  while  the  body  is  still 
warm,  but  according  to  Casper,  not  after  six  hours.  There- 
fore, this  particular  sign  should  never  be  relied  on  to  the 
exclusion  of  the  other  characteristic  evidences  of  death  by 
strangulation,  such  as  the  livid,  swollen  countenance,  the 
protruded  tongue,  the  staring  eyeballs,  etc.,  none  of  which 
are  produced  by  strangulation  after  death.  Hence,  although 
a  murderer  may  place  a  cord  around  the  neck  of  his  dead 
victim,  with  a  view  to  make  the  case  simulate  a  suicide, 
there  will  be  little  difficulty  in  detecting  the  ruse. 

Was  the  strangling  accidental,  suicidal,  ox  homicidal  ? 
Cases  of  accidental  strangulation  not  infrequently  occur. 
Taylor  records  two  :  one  of  a  girl  carrying  fish  in  a  basket, 
which  was  strapped  around  the  upper  part  of  her  chest  in 
front.  She  was  found  dead,  sitting  on  a  stone  wall.  The 
basket  had  probably  slipped  off  while  she  was  resting,  and 
had  thus  raised  the  strap,  which  firmly  and  fatally  com- 
pressed the  trachea.  The  other  case  was  that  of  a  boy, 
whose  silk  necktie,  knotted  and  tightly  twisted  around  his 


1 66  MEDICAL   JURISPRUDENCE. 

neck,  was  caught  in  the  band  of  an  engine,  and  his  neck 
drawn  down  against  one  of  the  revolving  shafts.  He  was 
rescued  after  his  neck  had  been  compressed  at  least  one 
minute.  He  became  black  in  the  face,  and  blood  escaped 
from  the  mouth  and  ears.  For  several  minutes  after  the 
removal  of  the  ligature  he  was  insensible,  but  ultimately 
recovered.  Another  instance  is  related  by  Dr.  Gordon 
Smith,  of  a  lad  who  used  to  carry  a  heavy  weight  sus- 
pended from  his  neck  by  a  string.  One  day  he  was  found 
dead,  sitting  in  a  chair.  He  had  probably  gone  to  sleep, 
the  weight  had  slipped,  and  drawn  the  cord  tight  around 
his  neck. 

Suicidal  strangulation  is  comparatively  rare,  except  among 
the  insane,  with  whom  it  is  by  no  means  uncommon.  The 
facility  of  effecting  their  purpose  by  such  simple  means  as 
a  garter,  a  ribbon,  a  handkerchief,  or  a  strip  torn  from  a 
garment,  may  readily  account  for  such  occurrences,  and 
still  further,  when  it  is  remembered  how  very  rapidly  and 
insidiously  unconsciousness  steals  over  the  senses  under  a 
pressure  of  the  windpipe,  thereby  taking  away  from  the 
individual  the  will  and  the  power  to  escape.  A  case  men- 
tioned by  Taylor  will  illustrate  this.  An  insane  man,  with 
suicidal  tendencies,  was  placed  in  a  private  asylum,  with 
special  directions  to  watch  him  closely  to  prevent  his  taking 
his  life.  Two  attendants  were  placed  over  him.  These 
attendants  remained  at  his  bedside  ;  but  on  his  requesting 
them  to  retire  to  a  little  distance,  they  complied,  still  keeping 
a  close  watch  upon  him.  Two  hours  afterward,  the  physi- 
cian on  visiting  the  patient,  was  informed  by  the  attendants 
that  he  had  been  sleeping  quietly  for  some  time.  On  ap- 
proaching the  bed  they  found,  to  their  surprise,  that  the 
man  was  dead.     He  had  strangled  himself   simply  by  tear- 


HOMICIDAL    STRANGULATION.  1 6/ 

ing  off  a  strip  from  the  bottom  of  his  shirt,  rolled  it  into  a 
cord,  and  tied  it  around  his  neck.  Other  cases  of  determined 
suicides  are  recorded,  in  which  the  cord  was  found  coiled 
around  the  neck  several  times  ;  in  one  instance,  the  ligature 
had  been  tightened  by  a  stick  thrust  in  and  twisted  like  a 
tourniquet ;  and  in  still  another,  a  sabre  had  been  used  for 
the  same  purpose. 

Homicidal  strangulation,  as  already  mentioned,  is  the 
most  frequent  variety  of  this  form  of  violent  death.  It  is 
usually  recognized  by  the  marks  upon  the  neck  and  else- 
where, indicating  a  greater  amount  of  violence  employed. 
Thus,  the  impression  of  the  Hgature  on  the  neck  will  be 
deeper  and  more  ecchymosed  than  occurs  in  a  suicide  ;  it 
may  also  be  accompanied  by  the  marks  of  the  fingers  on 
the  throat,  which  latter  are  never  found  either  in  a  suicidal 
or  accidental  case.  Besides  these,  there  will  frequently  be 
seen  contusions,  or  injuries  of  other  parts  of  the  body,  and 
evidences  of  a  struggle. 

It  should  not  be  forgotten  that  the  marks  of  homicidal 
strangulation  may  often  be  discovered  many  weeks,  or  even 
years,  after  burial.  One  is  mentioned  by  Wharton  and 
Stille,  where,  after  thirty -eight  days'  interment,  the  evidence 
of  strangulation  was  obtained  chiefly  from  the  striking  con- 
trast of  the  integuments  of  the  neck  with  those  of  the  rest 
of  the  body.  There  was  a  white,  shriveled  space  over  the 
larynx,  half  an  inch  broad ;  also  a  groove  around  the  neck, 
of  a  blackish-brown  color  and  parchment-like  appearance  ; 
this  condensed  skin  was  difficult  to  cut,  and  its  section  was 
perfectly  dry  and  yellowish-white.  Another  remarkable 
case  occurred  in  Paris,  where  the  body  had  been  buried 
several  years,  and  was  reduced  almost  to  a  perfect  skeleton. 
Several  of  the   cervical  vertebrae,  together  with  the  right 


1 68  MEDICAL    JURISPRUDENCE, 

clavicle,  were  found  held  together  by  a  blackish  mass,  in 
the  composition  of  which  no  tissue  could  be  recognized. 
This  mass  was  surrounded  by  several  twists  of  a  cord  two 
lines  in  diameter.  The  cord  was  much  decayed,  showing 
no  knots,  and  its  direction  was  horizontal.  The  above  facts 
enabled  Orfila  and  others  to  decide  that  the  woman  had  per- 
ished by  strangulation.  Another  remarkable  case  is  reported 
in  which  a  body  partially  burned  showed  evidence  of  pre- 
vious homicidal  strangulation  in  the  peculiar  horizontal  mark 
encircling  the  neck,  and  in  the  protrusion  of  the  tongue. 

The  case  of  the  Commonwealth  of  Pennsylvania  vs. 
Cutaire,  tried  in  1 896,  in  Philadelphia,  is  interesting  in  this 
connection.  A  carpenter,  in  repairing  a  house  in  the  north- 
ern part  of  the  city,  found  a  skeleton  under  the  kitchen 
floor.  There  were  some  fragments  of  clothes  and  jeweliy 
and  a  silk  handkerchief  which  had  been  tied  around  the 
neck  in  a  double  knot.  The  bones  were  promptly  identified 
as  those  of  a  woman  who  had  disappeared  some  fourteen 
years  before.  As  a  result  of  careful  detective  work,  a  man 
was  arrested,  tried,  and  convicted  of  the  murder.  He  was 
a  boy  of  about  fifteen  at  the  time  the  woman  disappeared. 
He  made  a  confession  declaring  that  he  buried  the  body,  but 
denied  that  he  killed  her.  Much  legal  controversy  occurred 
in  regard  to  the  case  and  the  prisoner  up  to  the  present  time 
(July,  1902)  is  still  in  jail. 

Hanging  is  that  mode  of  death  caused  by  suspension  of 
the  body  by  the  neck,  the  weight  of  the  body  acting  as  the 
constricting  force.  Physiologically,  it  is  the  same  as  stran- 
gulation, and,  like  the  latter,  the  cause  of  death  is  partly 
apnea  and  partly  cerebral  congestion,  and  more  frequently 
a  combination  of  the  two. 


HANGING.  169 

If  the  cord  encircles  the  neck  below  the  thyroid  cartilage 
the  death  is  more  rapid,  and  is  to  be  ascribed  to  apnea  ; 
but  if  higher  up,  as  in  executions,  where  it  is  apt  to  slip 
under  the  chin,  some  little  space  on  either  side  may  escape 
constriction,  so  as  to  admit  a  slight  amount  of  air  into  the 
lungs  ;  in  this  case,  the  death  will  be  slower,  and  be  due 
rather  to  cerebral  congestion.  In  the  great  majority  of 
cases,  however,  as  shown  by  the  above  table,  the  cause  of 
death  is  of  a  mixed  nature.  In  some  cases  of  public  execu- 
tions, in  which  the  fall  was  very  considerable,  and  in  which 
a  violent  rotary  swing  was  given  to  the  body  of  the  criminal 
at  the  moment  of  the  drop,  the  odontoid  process  of  the 
second  cervical  vertebra  has  been  found  either  fractured  or 
dislocated,  causing  immediate  death,  owing  to  pressure 
on  the  spinal  cord.  But  death,  in  hanging,  from  fracture  of 
the  vertebra,  is  far  less  frequent  than  is  supposed.  Orfila 
states  that  in  the  bodies  of  fifty  persons  who  had  been 
hanged,  he  met  with  a  fracture  of  the  os  hyoides  in  only 
one  case,  while  he  had  never  met  with  a  fracture  or  luxation 
of  the  vertebrae. 

Unconsciousness  very  speedily  supervenes  in  hanging, 
from  the  circulation  of  unaerated  blood,  especially  if  the 
trachea  is  compressed,  and  death  occurs  in  a  very  few 
minutes.  Persons  who  have  been  cut  down  after  a  few 
minutes'  suspension  are  very  rarely  resuscitated.  And  even 
after  an  apparent  partial  recovery,  death  often  follows  from 
secondary  effects,  especially  from  congestion  of  the  brain. 

The  insidious  manner  in  which  the  loss  of  consciousness 
steals  upon  the  brain  in  hanging  deserves  especial  notice, 
because  it  satisfactorily  explains  the  facility  with  which 
death  takes  place,  even  when  the  suspension  of  the  body  is 
not  complete,  but  when  there  has  been  simply  a  pressure 


I/O  MEDICAL    JURISPRUDENCE. 

of  the  ligature  against  the  windpipe,  the  person  meanwhile 
resting  on  the  knees  or  toes,  or  being  in  a  semi-recumbent 
posture. 

Post-inortcm  Appearances.  —  In  the  main,  they  resemble 
those  attending  death  from  strangulation.  Externally,  swell- 
ing and  lividity  of  the  face,  congestion  of  the  eyelids,  dilated 
pupils,  eyes  red  and  protruding,  tongue  swollen,  livid,  often 
protruded,  or  compressed  between  the  teeth,  lower  jaw  re- 
tracted ;  often  a  bloody  froth  escaping  from  the  mouth  and 
nostrils.  There  are  frequently  petechial  effusions  on  the 
neck,  shoulders,  arms,  and  hands.  In  many  cases,  how- 
ever, especially  in  suicides,  the  countenance  is  calm,  the  face 
pale,  the  eyes  and  tongue  natural.  Sometimes  there  is 
turgescence  of  the  genital  organs,  and  an  involuntary  escape 
of  the  urine,  feces,  and  semen  ;  but  these  signs  are  by  no 
means  peculiar  to  death  by  hanging.  The  position  of  the 
head  varies  according  to  the  part  of  the  neck  where  the  knot 
was  placed.  As  the  latter  is  usually  behind  the  neck,  the 
head  is  generally  flexed  forward.  If  the  knot  were  in  front, 
the  head  would  be  found  extended  backward  (Tardieu). 
The  hands  are  generally  closed,  often  tightly ;  the  legs  ex- 
tended, and  often  livid.  The  neck  is  nearly  always  stretched, 
owing  to  the  weight  of  the  body,  and  it  presents  very 
decided  marks  of  the  cord,  varying,  however,  somewhat 
according  to  the  nature  of  the  latter  and  its  mode  of  appli- 
cation. Thus,  the  mark  may  be  deep  or  superficial,  single 
or  double,  according  to  the  strain  made  upon  it,  and  the 
thickness,  roughness,  or  duplication  of  the  cord.  The  skin 
under  this  mark  becomes  very  dense  and  tough,  and  of  a 
yellowish-brown  color,  and  has  been  aptly  compared  to  old 
parchment.  This  appearance  is  more  marked  if  the  body 
has  remained  suspended  for  some  hours  or  days  ;    and  the 


SIGNS    OF    HANGING.  I/I 

cellular  tissue  underneath  is  also  condensed,  and  has  a 
silvery  appearance.  Besides  the  above,  there  is  often  a 
livid  mark  (ecchymosis),  where  great  violence  has  been 
used,  as  in  executions  ;  but  the  latter  is  quite  distinct  from 
the  true  mark  of  the  cord,  with  which  it  has  been  con- 
founded. The  livid  Hne  is  much  less  frequently  met  with 
than  was  formerly  supposed. 

The  groove  or  furrow  in  the  neck,  in  the  great  majority 
of  cases,  will  be  found  between  the  chin  and  larynx.  Lu- 
taud  states  that  it  is  above  the  larynx  in  nearly  four  fifths 
of  the  cases,  and  over  the  larynx  in  the  other  fifth.  Only 
twice  has  it  been  found  below  the  larynx.  Its  direction  is 
obhque  (which  distinguishes  it  from  strangulation)  ;  it  may 
also  be  double  (arising  from  a  double  fold  of  the  cord),  and 
irregular  or  interrupted.  It  is  more  marked  in  front,  less  so 
at  the  sides  and  below  the  ears,  and  ceases  behind.  In 
general,  the  narrower  the  ligature,  and  the  longer  the  sus- 
pension, the  deeper  the  furrow.  A  broad  leather  thong, 
pressing  only  by  its  borders,  might  produce  a  double  mark. 

Internally,  the  appearances  usually  accompanying  asphyxia 
are  met  with,  such  as  engorgement  of  the  lungs,  right  side 
of  the  heart,  and  venous  system,  with  dark  fluid  blood. 
Both  ventricles  of  the  heart  contain  blood,  if  the  death  has 
been  caused  by  apoplexy ;  if  by  asphyxia,  the  left  cavities 
are  found  empty,  while  the  right  side  of  the  heart  and  the 
large  vessels  are  engorged  with  blood.  The  subpericardial 
ecchymoses  of  Tardieu  are  not  observed.  The  lining 
membrane  of  the  larynx  and  trachea  is  deeply  congested, 
as  in  strangulation,  and  is  sometimes  coated  with  a  bloody 
froth,  though  less  so  than  in  strangulation  and  suffocation. 
The  vessels  of  the  brain  are  generally  congested,  but  extra- 
vasation of  blood  into  the  brain  or  upon  its  membranes  is 


172  MEDICAL   JURISPRUDENCE. 

extremely  rare.  The  brain  itself,  when  cut  into,  presents 
numerous  bloody  points.  The  kidneys  are  usually  con- 
gested ;  the  stomach  frequently  presents  evidences  of  such 
deep  congestion  as  to  suggest  the  idea  of  an  irritant  poison. 
The  same  is  true  also  of  the  intestines.  Yellowly  found 
coagulated  blood  on  the  mucous  membrane  of  the  stomach 
in  two  out  of  every  five  cases  of  death  by  hanging. 

An  exception  to  the  engorgement  of  the  lungs  in  hang- 
ing is  recorded  by  Dr.  Wilson,  of  Birmingham,  Ala.  The 
case  was  that  of  a  negro  aged  22  years.  The  heart  ceased 
beating  twelve  minutes  after  the  drop  fell.  The  post-mor- 
tem, made  one  hour  afterward,  showed  the  lungs  to  be 
completely  collapsed,  though  otherwise  normal ;  the  pleural 
cavities  entirely  free  from  fluid ;  right  heart  distended  with 
dark  blood.  Stomach  deeply  congested,  and  containing  a 
small  amount  of  blood.  Liver  and  kidneys  engorged,  and 
brain  congested.  The  above  appears  to  be  the  second 
recorded  case  of  collapsed  lungs  in  death  from  hanging,  the 
other  case  being  that  mentioned  by  Dr.  Massey,  of  Not- 
tingham, England,  of  an  executed  criminal,  whose  lungs 
were  found  in  a  state  of  extreme  collapse. 

Among  the  occasional  lesions  may  be  mentioned  fracture 
of  the  hyoid  bone  and  thyroid  cartilage,  and  rupture  of  the 
internal  and  middle  coats  of  the  common  carotid  artery. 

An  important  question  is  —  Was  the  death  caused  by 
hanging  ?  This  cannot  always  be  satisfactorily  determined 
by  mere  medical  evidence,  since  there  are  no  positive  or 
characteristic  signs  of  this  kind  of  death.  The  mere  sus- 
pension of  the  body  is  no  proof,  since  a  murderer  might 
easily  suspend  the  body  of  his  victim,  in  order  to  divert 
suspicion  from  the  true  cause  of  death.  The  mark  of  the 
cord  can  be  imitated  by  suspending  a  dead  body  by  the 


HANGING SUICIDAL,    HOMICIDAL,    OR    ACCIDENTAL.     1 73 

neck  immediately  after  death,  and,  according  to  Casper, 
even  up  to  seventy-two  hours  after,  especially  if  the  body 
be  forcibly  pulled  downward.  The  livid  or  ecchymosed  line 
is  less  likely  to  be  found  under  these  circumstances  than 
the  brownish,  parchment- like  furrow.  Hence,  it  follows 
that  the  mark  of  the  cord  cannot  be  regarded  as  positive 
evidence  of  death  by  hanging  ;  and  the  other  usual  signs, 
such  as  turgescence  and  lividity  of  the  face,  congested  eyes, 
swollen  tongue,  etc.,  are  all  met  with  in  strangling  and 
other  forms  of  death,  while  these  very  signs  may  be  absent 
in  certain  cases  of  hanging.  Dr.  R.  F.  Hutchinson  states 
that  an  invariable  sign  of  death  from  hanging  is  the  flow  of 
saliva  out  of  the  mouth,  down  the  chin,  and  straight  down 
the  chest.  The  appearance  is  unmistakable  and  invariable, 
and  could  not  occur  in  a  body  hung  up  after  death,  the 
secretion  of  saliva  being  a  living  act. 

To  determine  the  question  whether  the  hanging  was  sui- 
cidal, homicidal  or  accidental,  regard  must  be  had  to  the 
attending  circumstances  ;  remembering  always  that  hanging 
is  a  frequent  method  of  suicide.  Out  of  368  cases  of 
suicide  occurring  in  Berlin,  189  resulted  from  hanging. 
Hence,  the  presumption  is  always  in  favor  of  suicide ; 
besides  the  difficulties  that  would  attend  an  attempt  at  mur- 
der by  this  means.  If,  however,  the  body  exhibit  evidences 
of  great  violence  externally,  denoting  a  struggle  and  the 
presence  of  several  persons,  or  marks  of  the  fingers  about 
the  throat,  or  of  internal  laceration,  these  would  be  more 
consistent  with  homicide.  The  position  of  the  body  will 
throw  very  little  light  upon  the  question,  since  it  is  fully 
demonstrated  that  complete  suspension  is  not  necessary  to 
produce  death.  In  numerous  instances  the  body  has  been 
found,  after  death,  resting  upon  the  knees,  the  toes,  or  the 


1/4  MEDICAL    JURISPRUDENCE. 

buttocks,  or  semi-recumbent,  and  in  one  case  entirely  sup- 
ported by  the  bedstead,  while  the  neck  rested  in  a  loop  of 
leather. 

Even  if  the  hands  and  feet  are  found  tied,  the  inference  is 
not  warranted  that  the  act  was  homicidal,  since  determined 
suicides  have  been  known  to  perform  this  very  act  previous 
to  hanging  themselves.  Nevertheless,  if  a  person  be  found 
with  his  hands  and  feet  tied,  and  suspended  from  a  position 
which  obviously  he  could  not  have  reached  himself,  the 
presumption  of  homicide  would  certainly  be  justified. 

The  age  of  the  deceased  might  be  supposed  to  assist 
in  solving  the  question.  If  a  very  young  person  were 
discovered  dead  from  hanging,  it  would  naturally  be  attrib- 
uted to  homicide  or  accident ;  yet  numerous  instances  have 
occurred  in  this  country,  within  the  last  few  years,  of  sui- 
cidal hanging  in  children  not  over  twelve  or  fourteen  years 
of  age. 

Cases  of  accidental  hanging  are  of  occasional  occurrence, 
especially  among  children,  who  have,  while  swinging  or 
otherwise  playing,  accidentally  become  entangled  in  a  noose 
or  loop  of  cord,  which  was  then  drawn  tightly  enough 
around  the  neck  to  strangle  them. 

Drowning  is  that  special  form  of  death  by  suffocation  in 
which  the  breathing  is  arrested  by  water,  or  some  other 
liquid,  and  even  more  effectually  than  by  a  ligature  drawn 
around  the  neck.  It  is  not  necessary  that  the  whole  body 
should  be  submerged  in  order  to  cause  death  by  drowning. 
This  may  be  accomplished  by  merely  immersing  the  face, 
so  as  to  keep  the  nose  and  mouth  under  the  Hquid,  as  is 
witnessed  in  the  case  of  drunkards,  epileptics,  and  very 
young  children  falling  with  their  faces  into  very  shallow 


DROWNING.  175 

pools,  and  perishing  from  inability  to  extricate  themselves. 
In  drowning,  in  addition  to  the  usual  cause  of  death  by 
asphyxia — the  deprivation  of  air — there  is  superadded  the 
physical  impediment  of  the  introduction  of  water  into  the 
minute  air-tubes  and  vesicles  of  the  lungs  by  aspiration,  in 
the  violent  efforts  of  the  person  to  breathe.  This  is  demon- 
strated by  the  experiments  made  by  the  Committee  of  the 
Medico-Chirurgical  Society  of  London.  Two  dogs  of  the 
same  size  were  submerged  at  the  same  moment,  but  one 
had  his  windpipe  plugged,  so  as  to  prevent  the  ingress  of 
both  air  and  water,  while  the  other  had  not.  After  two 
minutes  they  were  taken  out  together ;  the  one  with  the 
windpipe  plugged  recovered  at  once  on  removing  the  plug  ; 
the  other  died.  In  three  experiments  dogs  with  their  wind- 
pipes plugged  were  kept  under  water  four  minutes,  and  re- 
covered perfectly  on  being  taken  out.  On  inspecting  the 
bodies  of  the  animals,  the  difference  was  at  once  manifest. 
In  those  that  were  simply  deprived  of  air  by  plugging  the 
windpipe,  the  lungs  were  congested  ;  but  in  those  that  had 
been  submerged  in  their  ordinary  condition  —  /.  e.,  actually 
drowned  —  the  lungs,  besides  being  congested,  exhibited  in 
their  bronchial  tubes  and  air  vesicles  a  bloody,  frothy  mucus, 
which  completely  filled  the  air  vesicles  and  small  tubes, 
forming  a  mechanical  impediment  to  the  ingress  or  egress 
of  air.  The  lungs  were  sodden  with  water,  heavy,  soft,  and 
doughy  to  the  feel,  and  pitted  on  pressure  of  the  finger.  In 
the  lungs  of  animals  that  recovered  after  a  short  submer- 
sion, very  little,  if  any,  of  this  mucous  froth  was  found  ;  its 
amount  was  always  proportionate  to  the  time  of  submer- 
sion. There  is  no  doubt  that  this  froth  is  produced  by  the 
violent  efforts  to  breathe  which  are  made  within  a  minute 
after  submersion. 


1/6  MEDICAL   JURISPRUDENCE. 

Hence,  the  probability  of  recovery  after  drowning  is 
mainly  dependent  upon  the  quantity  of  this  mucous  froth 
existing  in  the  air-tubes  and  vesicles  of  the  lungs,  and  also 
of  the  water  that  has  penetrated  into  the  substance  of  the 
lungs.  If  the  quantity  is  large,  the  result  is  almost  cer- 
tainly fatal ;  if  it  is  small,  there  is  always  good  hope  of  re- 
covery. Asphyxia  occurs  in  a  minute  to  a  minute  and  a 
half  after  submersion,  being  occasioned  by  the  circulation 
of  the  unaerated  blood,  though  actual  death  is  postponed 
for  a  minute  or  two  longer  until  the  heart  ceases  to  beat. 
If  the  submersion  has  been  complete  for  four  minutes,  the 
case  may  be  considered  hopeless,  unless  syncope  had  oc- 
curred at  the  moment  of  entering  the  water.  This,  by  par- 
tially suspending  the  attempts  at  respiration,  would  un- 
doubtedly tend  to  prolong  Hfe  for  some  minutes  longer. 
Cases  are  reported  of  resuscitation  after  being  fifteen  minutes 
under  water ;  but  these  are  exceptional,  and  were  probably 
cases  of  syncope,  occurring  at  the  moment  of  submersion. 
It  should  be  remembered  that  the  heart  may  continue  to 
beat  some  minutes  after  respiration  has  ceased ;  but,  in  the 
present  instance,  the  pulsation  of  the  heart  is  no  criterion 
of  the  power  of  recovery,  on  account  of  the  physical  im- 
pediment in  the  lungs  just  alluded  to. 

Taylor  gives  the  following  excellent  synopsis  of  the  cir- 
cumstances attending  a  case  of  drowning  :  "  When  a  person 
falls  into  the  water  and  retains  his  consciousness,  violent  at- 
tempts are  made  to  breathe  ;  at  each  time  that  he  rises  to 
the  surface,  a  portion  of  air  is  received  into  the  lungs ;  but 
owing  to  the  mouth  being  on  a  level  with  the  liquid,  water 
also  enters  and  passes  into  the  throat.  A  quantity  of  water 
thus  usually  enters  the  mouth,  which  the  drowning  person 
is  irresistibly  compelled  to  swallow.     In  his  efforts  to  breathe 


SIGNS    OF    DROWNING.  177 

while  his  head  is  below  the  water,  a  portion  of  this  liquid  is 
drawn  into  the  air-tubes  and  cells  of  the  lungs.  The 
struggle  for  life  may  continue  for  a  longer  or  shorter 
period,  according  to  the  age,  sex,  and  strength  of  the  per- 
son ;  but  the  result  is  that  the  blood  in  the  lungs  is  imper- 
fectly aerated,  the  person  becomes  exhausted,  and  insensi- 
bility follows.  The  mouth  then  sinks  altogether  below  the 
level  of  the  water ;  air  can  no  longer  enter  the  lungs  ;  a 
portion  of  that  which  they  contained  is  expelled,  and  rises 
in  bubbles  to  the  surface  ;  an  indescribable  feeling  of  deli- 
rium, with  a  ringing  sensation  in  the  ears,  supervenes  ;  the 
person  loses  all  consciousness,  and  sinks  asphyxiated.  In 
the  state  of  asphyxia,  while  the  dark-colored  blood  is  circu- 
lating, convulsive  movements  of  the  body  take  place,  and 
the  contents  of  the  stomach  are  sometimes  ejected  by 
vomiting.  There  does  not  appear  to  be  any  sensation 
of  pain  ;  and,  as  in  the  other  cases  of  asphyxia,  if  the  per- 
son recovers,  there  is  a  total  unconsciousness  of  any 
suffering." 

Even  after  resuscitation  from  drowning,  death  frequently 
takes  place  within  a  few  hours  or  days  from  secondary 
causes,  as  exhaustion,  obstruction  to  respiration  from  the 
condition  of  the  lungs,  convulsions,  and  spasm  of  the 
glottis. 

Signs  of  Death  by  Drotvning. —  i.  External.  These  vary, 
according  to  the  length  of  time  the  body  has  been  in  the 
water,  and  the  intei-val  after  it  was  taken  out.  Supposing 
the  immersion  not  to  have  been  over  two  or  three  hours, 
and  the  inspection  to  be  made  immediately,  the  face  will 
be  found  to  be  pale,  the  expression  placid,  the  eyes  half 
open,  the  eyelids  livid,  and  the  pupils  dilated,  the  mouth 

15 


178  MEDICAL   JURISPRUDENCE, 

half  closed  or  open,  the  tongue  swollen  and  congested,  often 
indented  by  the  teeth,  and  perhaps  lacerated  ;  the  lips  and 
nostrils  covered  with  a  mucous  froth,  which  issues  from 
them.  The  skin  is  cold  and  pale,  and  generally  contracted 
so  as  to  present  the  appearance  called  "  goose-skin."  This, 
being  a  vital  act,  is  a  pretty  sure  sign  that  the  body  was 
living  when  immersed  in  the  water.  It  is  not  dependent  on 
cold,  as  was  at  one  time  supposed.  Cadaveric  rigidity 
usually  comes  on  early  in  the  drowned,  hence  the  body  is 
often  found  with  the  limbs  stiffened.  Retraction  of  the 
penis  is  considered  by  Casper  and  Kanzler  as  a  positive 
sign  of  drowning. 

Besides  the  above,  there  are  sometimes  seen  marks  of 
abrasion  on  the  body,  especially  on  the  hands,  together 
with  sand,  gravel,  or  mud  under  the  nails,  weeds,  pieces  of 
wood,  or  other  matters  locked  in  the  hands,  all  of  which 
would  seem  to  indicate  that  the  person  had  been  alive  when 
first  immersed  in  the  water ;  although  the  abrasions  might 
very  possibly  have  resulted  from  the  body  rubbing  against 
some  rough  substances  after  death.  After  several  days' 
immersion,  the  palms  of  the  hands  and  soles  of  the  feet 
become  white,  thickened,  and  sodden,  the  result  of  imbibi- 
tion. 

If  putrefaction  has  commenced  before  the  body  is  re- 
moved from  the  water,  the  face  will  have  assumed  a  reddish, 
or  bluish-red  coloration. 

2.  Internal. — Along  with  the  usual  evidences  of  death 
from  asphyxia  (in  an  early  examination)  the  following  signs 
will  be  observed  :  the  lungs  are  distended,  overlapping  the 
heart,  and  are  in  a  flabby  condition  ;  this  latter  is  owing  to 
the  water  taken  in  by  aspiration,  during  the  struggles  for 
breath,  which  penetrates  even  the  air  vesicles,  and  renders 


SIGNS    OF    DROWNING.  1/9 

them  sodden  and  doughy.  When  cut  into,  the  lungs  exude 
a  bloody,  mucous  froth.  The  presence  of  this  froth  in  the 
smaller  tubes  and  air  cells,  together  with  the  sodden  con- 
dition of  the  lungs,  is  regarded  as  one  of  the  most  positive 
signs  of  death  by  drowning.  Nevertheless,  its  absence 
should  not  be  accepted  as  a  proof  against  drowning,  since 
it  has  not  been  found  in  the  bodies  of  persons  who  have 
sunk  at  once  in  the  water,  and  never  risen  to  the  surface  to 
breathe.  Ogston  states  that  in  48.7  per  cent,  of  cases,  no 
water  was  found  in  the  lungs,  and  he  accounts  for  its  ab- 
sence by  its  transudation  from  the  lungs  into  the  pleural 
cavities,  where  it  was  found  in  quantities  varying  from  one 
to  thirty-four  ounces.  In  a  case  examined  by  Dr.  Reese  a 
few  years  ago,  the  body  of  a  woman  taken  out  of  the 
Delaware,  there  was  an  absence  of  this  characteristic  froth 
in  the  minute  bronchial  tubes,  and  also  of  the  peculiar 
flabby  condition  of  the  lungs.  The  absence  of  these  pecu- 
liarities in  the  lungs  of  the  body  of  Jennie  Cramer,  at  New 
Haven,  created  a  feeling  in  the  minds  of  many  that  it  was 
not  a  case  of  suicide  by  drowning,  but  that  the  girl  was 
murdered  before  the  body  was  thrown  into  the  water.  The 
discovery  of  a  considerable  amount  of  arsenic  in  the  body 
of  the  deceased  was  sufficient  to  account  for  the  death. 
These  peculiar  conditions  of  the  lungs  of  the  drowned 
have  not  yet  been  sufficiently  determined.  It  is  quite  pos- 
sible that  some  cases  of  bodies  taken  out  of  the  water,  and 
reported  by  coroners'  juries  as  "  found  drowned,"  may  in 
reality  have  met  their  death  by  other  means,  prior  to  their 
immersion.  It  is  important  to  remember  that  the  presence 
of  this  mucous  froth  in  the  air  passages  is  not  seen  after 
putrefaction,  nor  after  long  exposure  of  the  body  to  the 
air,  nor  after  long  immersion.     It  is  also  stated  to  be  absent 


l80  MEDICAL   JURISPRUDENCE. 

in  those  who  remained  under  the  water  without  rising  to 
the  surface.  These  circumstances  may  account  for  the  fact 
of  its  occasional  non-observance  in  the  bodies  of  the 
drowned.  Devergie  and  other  authorities  state  that  this 
froth  is  occasionally  found  in  the  trachea  and  bronchi,  in 
deaths  from  other  causes. 

Another  important  indication  of  death  by  drowning  is 
the  presence  of  water  in  the  stomach,  which  had  been 
swallowed  in  the  act  of  drowning,  especially  if  this  corre- 
sponds with  the  water  in  which  the  body  was  found.  The 
value  of  this  is  enhanced  if,  along  with  the  water,  there  be 
discovered  in  the  stomach  fragments  of  weeds,  sand,  mud, 
or  other  articles,  corresponding  with  the  like  substances 
existing  in  the  pond  or  river  where  the  drowning  occurred. 
The  quantity  of  water  in  the  stomach  varies  considerably ; 
it  was  found  to  be  greater  in  an  animal  that  was  allowed  to 
come  to  the  surface  frequently  than  in  one  kept  completely 
submerged,  because  in  the  latter  the  power  of  swallowing 
was  sooner  lost,  in  consequence  of  the  early  occurrence  of 
asphyxia. 

The  absence  of  water  from  the  stomach  is  not  to  be  con- 
sidered as  disproving  a  case  of  drowning,  inasmuch  as  it  is 
not  present  (because  not  swallowed)  in  cases  where  either 
syncope  or  apoplexy  had  occurred  at  the  moment  of  im- 
mersion. 

The  mere  discoveiy  of  water  in  the  stomach  is  not  of 
itself  a  positive  indication  of  death  by  drowning,  since  it 
may  have  been  swallowed  before  immersion  ;  but  with  this 
allowance,  and  with  the  restrictions  above  mentioned,  it  does 
constitute  a  very  important  sign,  inasmuch  as  it  has  been 
ascertained  by  experiment  that  water  will  not  penetrate  into 
the  stomach  after  death,  unless  putrefaction  has  advanced 


SIGNS    OF    DROWNING.  l8l 

to  a  great  extent ;  consequently,  its  pfesetic^  indicates 
pretty  certainly  that  it  had  been  swallowed  in  the  act  of 
drowning.  Orfila's  experiments  prove  that  water  may 
penetrate  into  the  larger  bronchial  tubes  after  death,  but 
not  into  the  air  vesicles  of  the  lungs  ;  besides,  in  such 
cases,  there  is  no  accompaniment  of  mucous  froth  in  the  air 
tubes. 

The  condition  of  the  heart  affords  no  positive  indication 
of  death  by  drowning.  In  the  majority  of  cases,  the  right 
cavities  are  full,  and  the  left  ones  empty,  as  in  asphyxia 
generally  ;  but  very  often  the  two  sides  are  equally  full. 

The  brain  exhibits  no  characteristic  post-mortem  sign. 
There  may  be  some  general  fullness  of  the  vessels,  but 
never  extravasation  of  blood,  unless  a  sudden  apoplexy  had 
supervened,  as  when  a  person  plunges  suddenly  into  cold 
water  after  eating  heartily,  or  by  striking  the  head  against 
a  hard  body  in  the  act  of  diving. 

The  blood  is  usually  dark  and  fluid.  The  fluidity  of  the 
blood,  according  to  Brouardel,  is  owing  to  the  water  ab- 
sorbed into  the  circulation  through  the  pulmonary 'tissue ; 
and  this  is  much  more  decided  in  cases  where  the  person 
dies  slowly,  after  coming  to  the  surface  frequently,  than 
when,  through  syncope,  apoplexy,  or  drunkenness,  he  im- 
mediately sinks  to  the  bottom,  Brouardel  regards  the 
fluidity  of  the  blood,  the  empty  condition  of  the  heart,  the 
infiltration  of  the  lungs  with  water  and  froth,  and  the 
presence  of  broad,  ill-defined  subpleural  ecchymoses  as 
indicative  of  gradual  drowning  with  struggling  ;  while,  if 
the  blood  is  not  fluid,  if  there  are  punctated  subpleural 
ecchymoses,  and  clots  of  blood  in  the  heart,  and  rather  an 
absence  of  pulmonary,  watery  infiltration,  he  would  con- 
sider it  a  case  of  drowning  in  which  there  had  been  no 


I  82  MEDICAL    JURISPRUDENCE. 

struggle  made  to  breathe.  The  mucous  lining  of  the 
stomach  and  bowels  is  usually  congested  and  of  a  deep 
violet  color  if  the  body  had  been  long  in  the  water  ;  this 
might  lead  to  the  suspicion  of  irritant  poisoning,  as  is  seen 
also  in  hanging.  Occasionally,  in  cases  of  drowning,  after 
a  full  meal,  vomiting  occurs,  and  the  contents  of  the 
stomach  are  found  in  the  windpipe  and  lungs  ;  this  is  a 
conclusive  evidence  that  the  person  must  have  been  alive 
at  the  time. 

The  time  at  which  the  bodies  of  the  drowned  will  float 
varies  with  the  temperature  of  the  air,  the  water,  the  age, 
sex,  and  corpulence.  As  the  human  body  is  slightly  heavier 
than  water,  it  must  remain  submerged  until  it  becomes 
lighter  through  the  development  of  the  gases  of  putrefac- 
tion. Hence,  in  summer  the  body  may  rise  within  twenty- 
four  hours.  In  salt  water  it  will  float  sooner  than  in  fresh  ; 
very  fat  bodies  float  sooner  than  lean  ones  ;  the  bodies  of 
women  and  those  of  young  children  sooner  than  those  of 
men.  Hence,  in  infanticide  by  drowning,  the  infant's  body 
speedily  rises  to  the  surface. 

To  determine  the  time  that  has  elapsed  since  the  act  of 
drowning,  when  the  body  is  discovered  in  the  water,  is  not 
always  possible.  After  putrefaction  has  set  in,  it  is  mere 
guesswork.  The  most  certain  criteria  to  guide  the  ex- 
aminer are  the  presence  of  the  mucous  froth  in  the  air- 
tubes  and  cells,  and  the  presence  of  water  in  the  lung  tissue, 
both  of  which  indications  disappear  after  exposure  to  the 
air  and  after  putrefaction.  Hence,  the  importance  of  an 
early  inspection.  Devergie,  who  has  given  particular  atten- 
tion to  this  subject,  offers  the  following  observations : 
During  the  winter,  for  the  first  three  days  there  is  no  change. 
From  three  to  five   days  there  is  cadaveric   rigidity ;  the 


SIGNS    OF    DROWNING.  1 83 

palms  of  the  hands  begin  to  blanch.  From  four  to  eight 
days  the  limbs  become  supple,  but  still  retain  their  natural 
color  ;  the  palms  of  the  hands  are  very  white.  From  eight 
to  fifteen  days  the  face,  at  first  pale,  becomes  red  in  places 
and  bloated ;  the  skin  on  the  back  of  the  hands  and  on  the 
feet  is  blanched ;  a  greenish  appearance  at  the  base  of  the 
sternum.  In  one  month  the  skin  on  hands  and  feet  is  very 
white  and  in  folds,  the  face  reddish-brown,  the  eyelids  and 
lips  greenish,  with  a  reddish-brown  patch,  surrounded  by  a 
greenish  zone  on  the  front  of  the  chest.  In  two  months 
the  epidermis  of  the  hands  and  feet  to  a  great  extent  is 
softened  and  detached,  the  face  generally  swollen,  and  of  a 
brownish  color  ;  hair  falHng  out ;  nails  still  adherent.  In 
three  months,  commencing  saponification,  especially  in 
women,  about  the  face  and  neck,  breasts,  groins,  and 
thighs  ;  nails  loosened.  In  four  months  saponification  has 
progressed  on  the  face,  neck,  and  thighs,  and  commenced  in 
the  brain  ;  general  softening  and  destruction  of  the  hairy 
parts  of  the  skin. 

If  the  foregoing  observations  made  in  the  winter  were 
applied  to  the  summer,  the  following  allowances  are  to  be 
made  :  five  to  eight  hours'  continuance  in  the  water  in  sum- 
mer are  equivalent  to  three  to  five  days  in  winter ;  twenty- 
four  hours  in  summer,  to  four  to  eight  days  in  winter ;  four 
days,  to  fifteen  days  ;  and  twelve  days,  to  one  month,  or 
six  weeks. 

If  marks  of  violence  be  found  on  the  bodies  of  the 
drowned,  of  course  suspicion  will  be  aroused  of  foul  play, 
unless  these  marks  can  be  satisfactorily  attributed  to  some 
post-mortem  cause.  A  murderer  may  destroy  his  victim, 
and  then  throw  the  body  into  a  river,  pond,  or  well,  with 
the  intention  to  elude  suspicion  of  the  real  cause  of  death. 


184  MEDICAL   JURISPRUDENCE. 

A  close  examination  of  the  body  for  wounds  and  other 
injuries,  together  with  the  absence  of  the  known  signs  of 
drowning,  will  generally  enable  the  examiner  to  form  a 
correct  conclusion.  Tardieu  regards  the  presence  of  sub- 
pleural  ecchymoses,  together  with  subpericranial  and  sub- 
pericardial  effusions,  as  indicative  of  a  preceding  suffocation. 

Throwing  into  rivers  or  pools  is  a  very  common  method 
of  disposing  of  bodies  in  cases  of  infanticide. 

The  question  of  accident,  homicide,  or  suicide,  in  the  case 
of  drowning,  must  claim  the  attention  of  the  legal  physician. 
Homicidal  drowning  is  rare,  except  in  the  case  of  infants. 
It  is  denoted  by  the  marks  of  violence  on  the  body,  which 
cannot  be  explained  by  any  post-mortem  influence.  It 
should  be  remembered  that  determined  suicides  frequently 
inflict  dangerous  wounds  upon  themselves,  and  then  termi- 
nate their  lives  by  drowning.  Such  cases  might  possibly 
be  mistaken  for  homicide.  The  presence  of  the  usual  signs 
of  drowning  would  at  least  show  that  the  body  was  alive  at 
the  time  of  immersion.  Suicidal  and  accidental  drowning 
cannot  always  be  distinguished  from  each  other ;  inferences 
may,  however,  be  drawn  from  the  circumstances  attending 
the  cases,  as  the  existence  of  a  motive  to  suicide,  or  a  ten- 
dency thereto  through  melancholia.  The  proximity  of  a 
precipice,  or  other  dangerous  place,  to  the  water  in  which 
the  deceased  was  found,  would  naturally  suggest  accident, 
especially  in  the  case  of  a  child.  The  tying  of  the  hands 
and  feet  of  a  person  found  dead  in  the  water  is  no  proof  of 
homicide,  since  many  instances  are  recorded  of  suicides  so 
binding  themselves,  and  of  attaching  heavy  weights,  before 
throwing  themselves  into  the  water. 

The  restoration  of  the  drowned  depends  chiefly  on  excit- 
ing artificial  respiration.      The  clothes  should  be  immediately 


DEATH    BY    LIGHTNING.  1 85 

removed,  and  the  body  quickly  wiped  dry  and  wrapped  in 
a  blanket ;  clear  the  mouth  and  nostrils  of  mucus  and 
water ;  draw  forward  the  tongue ;  place  the  body  with  the 
face  downward,  the  forehead  resting  on  one  arm,  for  a  few 
moments,  to  allow  the  fluids  to  run  out  of  the  mouth  ;  apply 
ammonia  cautiously  to  the  nose.  If  respiration  is  not  re- 
stored, place  the  body  on  the  back,  with  the  head  raised, 
and  adopt  Sylvester's  process  of  artificial  respiration,  by 
carrying  the  arms  gently  outward  and  upward  above  the 
head  for  a  few  seconds  :  this  movement  expands  the  chest. 
Then  lower  the  arms  and  bring  them  to  the  sides  of  the 
chest ;  by  this  action  expiration  is  effected.  These  alter- 
nate movements  should  be  made  each  about  every  two 
seconds.  All  rough  handling,  such  as  the  vulgar  plan  of 
rolling  on  a  barrel,  should  be  avoided.  As  soon  as  any 
signs  of  respiration  are  manifested,  warmth  should  be 
applied  to  the  skin  by  a  warm  bath  or  stimulating  friction. 
When  able  to  swallow,  the  patient  may  take  a  little  warm 
spirit  and  water,  and  then  be  put  to  bed  and  allowed  to 
sleep.  This  treatment  has  been  rewarded  with  success, 
after  being  persisted  in  for  some  hours. 

DEATH  BY  ELECTRICITY. 

Death  caused  by  Lightning  is  often  accompanied  by 
results  which  resemble  veiy  strongly  the  effects  of  homi- 
cidal violence. 

Experience  shows  that  persons  out  of  doors,  especially 
under  trees,  are  much  more  Hable  to  be  struck  by  lightning 
than  those  within  doors. 

The  fatal  effects  of  lightning  are  usually  instantaneous, 
death  being  caused  by  shock.  At  times,  however,  it  pro- 
duces lesions  of  the  brain  and  spinal  cord,  such  as  epilepsy, 
16 


1 86  MEDICAL   JURISPRUDENCE. 

paralysis,  effusion  of  blood,  tetanus,  etc.,  which  may  subse- 
quently prove  fatal.  Generally  speaking,  if  death  does  not 
follow  immediately,  or  soon  after,  there  may  be  hopes  of 
recovery. 

The  visible  effects  produced  by  a  fatal  lightning  stroke 
are  remarkably  varied.  Sometimes,  a  deep,  punctured  or 
lacerated  wound  will  indicate  where  the  fatal  blow  was 
struck,  upon  the  head,  neck,  or  other  part  of  the  body ;  the 
hair  may  be  singed,  or  burnt  off;  the  clothing  may  be  burned 
or  completely  stripped  off;  the  boot  may  be  split  open. 
Again,  the  course  of  the  electric  current  may  be  marked 
by  a  deep  or  superficial  burn,  extending  from  the  point  of 
entrance,  down  and  around  the  body,  to  the  ground.  If 
there  should  happen  to  be  any  metallic  substances  in  con- 
tact with  the  body,  such  as  chains,  coins,  a  watch,  etc.,  as 
these  are  good  conductors  of  the  electric  current,  it  will  be 
certain  to  include  them  in  the  circuit,  and  they  will  be  fre- 
quently found  to  have  been  melted. 

In  other  cases  of  death  by  lightning,  no  external  wound 
or  burn  may  be  visible.  Sometimes  there  may  be  severe 
external  injuries,  while  the  clothes  entirely  escape.  Again 
the  clothing  may  be  completely  torn  off  the  body,  while  the 
latter  exhibits  no  injury  whatever. 

The  capricious  action  of  the  discharge  is  shown  by  the 
fact  that  out  of  a  party  of  three  or  four  sitting  under  a  tree, 
one  or  two  only  may  be  killed,  and  the  others  escape. 
Again,  it  has  occurred  that  persons  under  a  loza  tree  have 
been  struck,  although  high  trees,  and  a  lightning  rod,  and 
an  iron  bridge  were  near.  Again,  the  same  discharge  may 
produce  in  one  person  wounds,  and  burns  in  another.  The 
diversity  of  its  action  on  the  clothes  may  probably  be 
explained  by  the  circumstances  of  a  portion  of  the  clothing 


DEATH    BY    LIGHTNING.  1 8/ 

being  wet,  and  a  portion  dry ;  the  former,  being  a  good 
conductor,  might  escape  the  disruption  which  would  be 
exhibited  by  the  diy  portion,  which  is  a  bad  conductor. 

Post-mortem  Appearances. — In  case  of  instantaneous  death, 
the  body  may  be  found  in  the  exact  attitude  in  which  it  was 
struck.  Some  remarkable  instances  of  this  are  recorded  in 
the  books.  In  such  cases,  the  rigor  mortis  occurs  imme- 
diately after  death.  Hunter  supposed  that  there  was  an 
absence  of  the  usual  rigidity  after  death  ;  but  in  this  he  was 
in  error.  Coagulation  of  the  blood  also  occurs,  although 
it  is  delayed.  The  face  is  often  bloated  and  discolored, 
and  putrefaction  is  usually  very  rapid.  Wounds  of  various 
character  are  observed  —  contused,  lacerated,  and  punc- 
tured ;  also  burns,  vesications,  and  ecchymoses  ;  these  latter 
sometimes  exhibit  a  remarkable  arborescent  appearance. 
Occasionally,  fractures  of  the  skull  and  of  other  bones  are 
noticed.     The  blood  is  dark  and  fluid. 

The  brain  and  its  membranes  generally  suffer  most 
severely,  the  head  being  usually  the  first  part  struck.  Con- 
gestion of  the  brain,  effusion  of  blood  under  the  skull  and 
into  the  ventricles,  and  even  complete  disorganization  of  the 
brain  substance  have  all  been  observed.  The  lungs  are 
sometimes  found  congested  and  injured,  and  the  air-tubes 
full  of  mucus.  The  stomach,  intestines,  liver,  and  spleen 
are  also  usually  much  congested.  The  heart  does  not 
exhibit  any  special  alteration. 

The  medico-legal  interest,  in  cases  of  death  from  light- 
ning, is  centered  in  the  question  of  being  able  to  identify 
such  cases,  and  to  distinguish  them  from  those  of  homicidal 
violence.  A  close  observation  of  all  the  circumstances  of 
the  case  —  such  as  the  occurrence  of  a  thunder-storm  about 
the  time  of  the  death,  the  peculiar  appearance  of  the  wounds 


1 88  MEDICAL   JURISPRUDENCE. 

and  burns,  especially  if  the  two  co-exist  on  the  same  body, 
the  half-melted  appearance  of  metallic  articles,  such  as 
buttons  and  coins,  on  the  person  of  the  deceased,  etc., — 
will  tend  to  throw  much  light  upon  it. 

The  introduction  of  electricity  into  very  general  use,  in 
civilized  countries,  as  a  source  of  illumination  and  as  a 
motor  force,  has  been  the  occasion  of  numerous  fatal  results, 
arising  from  the  accidental  contact  of  individuals  with  the 
detached  conducting  wires  employed.  These  deaths  have 
sometimes  been  accompanied  with  excessive  burning  of  the 
bodies  of  the  unfortunate  victims,  at  the  points  of  contact 
of  the  wires. 

Electric  currents  may  be  either  continuous  or  alternating. 
In  the  former  (sometimes  called  "  direct  ")  the  current  flows 
constantly  in  the  same  direction  ;  in  the  latter,  there  are 
rapid  changes  in  direction,  usually  more  than  one  hundred 
a  second.  Sometimes  the  electric  current  is  sent  in  rapid 
impulses  ;  these  are  called  polyphase  currents.  It  is  gener- 
ally thought  that  alternating  are  more  dangerous  than 
direct  currents  of  corresponding  voltage.  Incandescent 
systems  are  often  run  on  no  or  220  volts,  and  are  not  suf- 
ficient to  do  serious  harm.  Trolley-car  lines  are  usually 
supplied  with  a  continuous  current  at  about  600  volts  which 
is  dangerous.  Street  arc-lamps  are  almost  always  supplied 
at  high  pressure,  often  several  thousand  volts,  and  alternat- 
ing currents  are  largely  used  in  such  installations.  These 
are  the  most  frequent  causes  of  death.  In  Philadelphia,  a 
man  w^as  instantly  killed  by  accidentally  touching  the  end 
of  an  umbrella  to  the  lower  portion  of  an  arc-lamp. 

Subjection  to  currents  of  high  intensity  has  been  made 
the  means  of  execution  in  the  State  of  New  York,  and  has 
been    applied   in   a  number   of  cases.     The  absurd   term 


EFFECTS  OF  HEAT  AND  COLD.  1 89 

"  electrocution,"  invented  by  newspaper  reporters,  has  been 
applied  to  this  method.  The  prison  authorities  of  New 
York  are  apparently  satisfied  with  the  system. 

It  must  be  borne  in  mind  that  while  telephone  wires  do 
not  carry  dangerous  currents,  they  may  at  any  time  be 
charged  to  a  fatal  extent  by  contact  with  wires  carrying 
heavy  currents.  Another  source  of  danger  is  that  alternating 
currents  of  high  voltage  used  for  indoor  service,  such  as 
incandescent  lights  and  fans,  are  reduced  to  very  low  voltage 
by  transformers,  but  these  may  get  out  of  order  and  allow 
the  full  pressure  street  current  to  pass  into  the  house  wires. 

DEATH  FROM  HEAT  AND  COLD. 
The  effects  of  extreme  Heat  on  the  human  system  are 
familiarly  witnessed  in  tropical  and  semi-tropical  climates, 
during  the  heated  term,  in  the  mortality  arising  from  what 
is  popularly  denominated  sunstroke.  In  such  cases,  the 
dangerous  and  fatal  results  are  attributable  directly  to  solar 
heat.  But  effects  equally  serious  are  known  to  be  produced 
by  exposure  to  artificial  heat,  if  too  long  continued,  as  is 
witnessed  in  those  employed  in  engine-rooms,  factories,  etc., 
where  a  very  high  temperature  is  habitually  maintained. 
There  would  seem  to  be,  according  to  the  observations  of 
Wood,  three  distinct  conditions  of  the  human  body  occa- 
sioned by  excessive  heat ;  in  the  first  (which  is  rare),  we  have 
acute  meningitis  or  phrenitis  (sunstroke);  in  the  second, 
we  have  heat-exhaustion  with  collapse,  accompanied  by  a 
rapid,  feeble  pulse,  a  cool,  moist  skin,  and  a  tendency  to 
syncope;  in  the  third,  we  have  true  thermic  fever — that 
condition  which  results  especially  from  exposure  to  artificial 
heat.  But  something  more  than  mere  heat  is  required  to 
produce  thermic  fever.     It  does  not  occur  in  a  perfectly 


190  MEDICAL   JURISPRUDENCE. 

pure  and  dry  atmosphere,  because  the  profuse  perspiration 
which  is  immediately  developed  by  its  rapid  evaporation 
keeps  the  temperature  of  the  body  down  nearly  to  the  nor- 
mal standard.  If,  however,  the  air  is  already  saturated  with 
moisture,  this  will  prevent  the  evaporation  from  the  body, 
and  its  temperature  will  rise  to  a  dangerous  height. 

The  symptoms  vary  in  intensity,  from  a  mere  headache 
with  drowsiness,  to  complete  insensibility,  coma,  and  pa- 
ralysis. In  many  instances,  death  appears  to  be  caused  by 
paralysis  of  the  heart. 

The  post-mortem  appearances  are  by  no  means  constant. 
In  some  cases  (true  sunstroke)  we  find  decided  congestion 
of  the  brain  and  its  membranes,  with  serum  in  the  ventricles, 
together  with  congestion  of  the  lungs  and  of  the  abdominal 
viscera  generally,  and  the  heart  as  in  ordinary  death  from 
asphyxia.  In  other  cases,  there  is  anemia  of  the  substance 
of  the  brain,  along  with  distention  of  the  larger  vessels  with 
dark,  fluid  blood,  but  the  minute  vessels  empty. 

Cases  of  insolation  do  not  often  claim  the  attention  of  the 
legal  physician,  yet  as  they  might  occur  remote  from  wit- 
nesses, and  with  a  fatal  termination,  it  is  proper  that  the 
medical  examiner  should  understand  their  nature,  together 
with  the  ordinary  accompaniments. 

The  effects  of  Cold  upon  the  animal  body  are  immediately 
depressing  ;  but  if  it  be  of  short  duration,  and  the  system  is 
in  good  health,  reaction  takes  place.  The  human  body  has 
the  power  to  maintain  its  normal  temperature  of  about 
98.6°  F.  independently  of  the  external  temperature.  It  has 
been  ascertained  by  actual  experiment  that  a  warm-blooded 
animal  will  not  survive  if  its  temperature  is  reduced  down 
16  to  20  degrees  below  the  normal.  There  is  no  authentic 
account  of  the  recovery  of  a  warm-blooded  animal,  much 


EFFECTS  OF  HEAT  AND  COLD.  I9I 

less  a  human  being,  after  the  whole  body  was  frozen,  al- 
though fishes  and  other  of  the  lower  animals  are  said  to 
have  been  resuscitated  from  a  frozen  state. 

Death  from  cold  is  hastened  by  whatever  exhausts  the 
system,  as  fatigue,  both  bodily  and  mental,  loss  of  rest,  want 
of  proper  food  and  nourishment,  mental  depression,  and 
particularly  intoxication.  A  damp  cold  (such  as  wet  cloth- 
ing) is  more  dangerous  than  a  dry  one.  The  fatal  effects 
of  exposure  to  cold  are  witnessed,  even  in  comparatively 
temperate  cHmates,  during  the  winter,  in  the  cases  of  the 
destitute,  and  especially  where  this  condition  is  associated 
with  intemperance. 

Cases  of  death  from  cold  do  not  often  require  the  atten- 
tion of  the  medical  jurist.  There  are,  however,  certain 
conditions  under  which  they  may  occur  which  demand  a 
brief  consideration. 

Every  body  in  which  it  is  assumed  that  death  has  taken 
place  from  exposure  to  cold  should  be  examined  as  soon 
as  found  to  determine  the  proofs  of  death.  Herris  records 
a  case  in  which  an  infant  was  removed  to  an  undertaker's 
establishment,  presumably  dead  ;  many  hours  afterward, — 
the  exact  time  is  not  given,  —  when  he  called  to  make  the 
autopsy  and  while  in  conversation  with  the  undertaker  in 
an  adjoining  room,  their  attention  was  attracted  by  the 
crying  infant,  which  by  energetic  efforts  was  completely 
resuscitated. 

A  not  infrequent  form  of  infanticide  is  the  exposure  of  a 
new-born  child  to  very  cold  air.  Death  will  soon  ensue 
under  such  circumstances,  since  the  infant's  power  of  resist- 
ance to  cold  is  limited.  In  such  a  case  it  will  be  the  physi- 
cian's duty  to  examine  the  body  of  the  child  and  consider 
the  accompanying  circumstances,  such  as  the  place  where 


192  MEDICAL   JURISPRUDENCE, 

it  was  found,  the  temperature  of  the  air,  the  possibiHty  of 
its  being  accidental,  etc.  As  regards  the  body,  he  should 
notice  if  the  pallor  is  extreme  ;  if  frozen  stiff,  he  should 
distinguish  this  rigidity  from  rigor  mortis  ;  also  the  arterial 
color  of  the  blood  ;  the  accumulation  of  blood  on  both 
sides  of  the  heart  and  in  the  larger  vessels.  There  may 
also  be  marks  of  violence  upon  the  body. 

Occasional  instances  of  the  exposure  of  young  children 
to  cold  with  homicidal  intent  are  recorded.  Such  a  case  is 
related  of  two  inhuman  parents  causing  the  death  of  a 
daughter,  aged  eleven  years,  by  compelling  her  to  get  out 
of  bed  on  a  very  cold  night  and  place  herself  in  a  vessel  of 
ice-cold  water. 

In  the  treatment  of  the  insane,  the  barbarous  and  im- 
proper use  of  the  cold  shower  bath  for  reducing  intractable 
patients  to  submission  was  formerly  much  more  in  vogue 
than  at  present.  It  need  hardly  be  said  that  such  treat- 
ment is  extremely  hazardous,  and  it  has  been  followed  by 
fatal  results.  Taylor  records  an  instance  of  a  lunatic,  aged 
sixty-five,  who  was  subjected  to  the  cold  shower  at  45°  F., 
and  who  afterward  took  a  dose  of  tartar  emetic ;  he  died  in 
fifteen  minutes  subsequently.  Cases  of  this  character  would 
very  properly  come  under  the  notice  of  the  legal  authorities. 

Post-mortem  Appearances.  —  These  cannot  be  considered 
as  very  characteristic ;  hence,  the  examiner  should  be  cau- 
tious in  deciding,  in  any  given  case,  as  to  whether  exposure 
to  cold  was  the  primary  cause  of  death.  All  the  circum- 
stances of  the  case  here  require  special  consideration,  such 
as  the  season  of  the  year,  the  temperature  of  the  air,  the 
place  of  exposure,  etc.  Rigor  mortis  generally  sets  in 
slowly  and  lasts  a  long  time.  According  to  Ogston,  the 
four  following   appearances,   in   the  absence  of  any   other 


DEATH    BY    STARVATION.  1 93 

obvious  cause,  would  justify  the  conclusion  that  the  death 
had  resulted  from  cold,  although  the  signs  were  not  so  well 
marked  in  children  as  in  adults  : 

1.  An  arterial  hue  of  the  blood,  except  when  viewed 
in  mass  within  the  heart ;  some  exceptions  are,  however, 
noted. 

2.  An  unusual  accumulation  of  blood  on  both  sides  of 
the  heart. 

3.  Pallor  of  the  general  surface  of  the  body  and  con- 
gestion of  the  viscera  most  largely  supplied  with  blood.  In 
some  cases,  the  congestion  of  the  brain  and  liver  was  only 
moderate. 

4.  Irregular  and  diffused  dusky- red  patches  on  limited 
portions  of  the  exterior  of  the  body,  even  in  non-dependent 
parts  (distinguishing  them  from  suggillations). 

As  putrefaction  does  not  occur  at  a  freezing  temperature, 
the  discovery  of  a  decomposing  corpse  in  the  ice  or  snow 
would  afford  very  strong,  though  not  absolutely  conclusive, 
evidence  that  the  death  was  not  the  result  of  exposure  to 
cold,  but  rather  that  the  body  had  been  frozen  after  death. 

DEATH  BY  STARVATION. 

Cases  of  death  by  Starvation  are  of  sufficiently  frequent 
occurrence  to  merit  the  notice  of  the  medical  jurist.  Acute 
starvation  implies  the  sudden  and  complete  deprivation  of 
all  food.  Chronic  starvation  is  the  result  of  a  continued 
deficient  supply  of  food,  both  in  quantity  and  quality.  Homi- 
cidal death  from  acute  starvation  is  very  rare;  but  cases 
of  accidental  death  from  this  cause  are  sufficiently  nu- 
merous, as  in  the  instances  of  miners  buried  in  the  eaith, 
shipwrecked  mariners,  and  others  cut  off  from  food.  Oc- 
casionally, prisoners  and  lunatics  will  undertake  to  commit 


194  MEDICAL   JURISPRUDENCE. 

suicide  by  voluntary  abstinence  from  all  food ;  in  the 
majority  of  cases,  however,  courage  fails  after  some  days' 
experience  and  they  give  up  the  attempt. 

Many  cases  of  voluntary  fasting  which  have  claimed  the 
notice  of  the  public  during  the  past  years  have  proved,  on 
close  examination,  to  be  deceptions,  food  and  drink  having 
been  supplied  surreptitiously  to  the  individuals  concerned. 
Among  these  instances  may  be  mentioned  the  case  of  Aim 
Moore,  of  Tetbury,  England,  who  was  alleged  to  have 
abstained  from  all  food  from  1807  to  18 13.  Another  case 
was  that  of  the  Welsh  Fasting  Girl,  aged  thirteen  years, 
who  is  stated  to  have  absolutely  fasted  for  two  years.  Both 
these  cases  were  shown  to  be  impostures.  The  notorious 
Dr.  Tanner,  of  our  own  countiy,  undertook,  for  a  consider- 
ation, to  perform  the  feat  of  a  forty  days'  absolute  fast,  in 
New  York,  in  August,  1880,  and,  to  all  appearance,  he 
accomplished  it.  It  is  stated  that  during  all  this  time  he 
partook  of  nothing  save  some  ounces  of  pure  water  each 
day,  and  that  his  loss  of  weight  at  the  end  of  forty  days 
was  thirty-six  pounds.  The  fluctuations  in  his  pulse,  tem- 
perature, and  respiration  were  unimportant.  This  case  was 
not  under  very  strict  medical  supervision,  and  the  doubt  as 
to  its  genuineness  seems  to  be  confirmed  by  the  fact  of  his 
voracious  feeding  on  the  completion  of  the  fast,  unattended 
by  any  bad  effects,  which  is  contrary  to  the  general  expe- 
rience of  others  who  have  been  deprived  of  food  for  a 
length  of  time.  Since  the  above  case,  several  instances  are 
recorded  of  voluntary  fasting  for  periods  varying  from 
several  weeks  to  some  months ;  but  there  is  nearly  always 
some  uncertainty  as  to  absolute  fasting. 

Chronic  starvation,  as  the  result  of  disease,  is  a  frequent 
cause  of  death,  as  is  witnessed  in  stricture  of  the  esophagus, 


DEATH    BY    STARVATION.  1 95 

cancer,  and  other  disorders  of  the  stomach  and  bowels,  dis- 
ease of  the  pancreas,  marasmus,  etc.  It  is  Hkewise  the 
cause  of  disease  and  death  in  young  children  fed  upon  un- 
suitable milk,  as  when  this  fluid  is  deficient  in  some  of  its 
proper  constituents.  Such  cases  are  abundantly  illustrated 
in  the  miserable  victims  of  baby-farming.  Chronic  starva- 
tion is  also  witnessed  on  a  large  scale  in  districts  where 
famine  has  prevailed,  as  in  certain  parts  of  India,  and  in  the 
Irish  famine  of  1847. 

The  symptoms  of  chronic  starvation  are  generally  well- 
marked.  The  sense  of  hunger  is  not  very  urgent ;  emacia- 
tion, especially  in  the  last  stage,  is  extreme  ;  the  eyes  are 
hollowed,  the  pupils  dilated  ;  the  skin  is  harsh  and  dry,  and 
hangs  loosely  over  prominent  bones,  and,  in  chronic  cases, 
becomes  covered  with  a  brownish,  dirty-looking  coating,  and 
exhales  an  offensive  odor,  like  that  of  putrefaction.  The 
bowels  are  either  very  constipated  or  the  feces  are  scanty, 
dry,  and  dark-colored.  There  is  great  muscular  debility, 
palpitation,  with  tinnitus  auriiim  ;  pains  in  the  stomach, 
with  a  dry,  parched  mouth  ;  the  intellect  sometimes  clouded, 
but  again  clear  to  the  end,  with  despondency  of  mind.  The 
pulse  is  at  first  somewhat  quickened,  afterward  it  is  slower ; 
the  temperature  is  usually  below  that  of  health. 

Post-mortem  Appearances. — Great  emaciation  of  the  body, 
with  an  almost  entire  loss  of  fat  ;  sunken  cheeks  and  eyes. 
The  skin  shriveled,  and  emitting  a  disagreeable  odor.  The 
muscles  soft,  pale,  and  wasted.  The  brain  sometimes  con- 
gested, and  at  others  pale  and  soft,  with  effusion  of  serum 
on  the  surface  and  in  the  ventricles  ;  the  lungs  healthy  or 
anemic  ;  the  heart  more  or  less  contracted  and  void  of  blood  ; 
stomach  and  intestines  contracted,  thin,  and  transparent ;  the 
latter  usually  empty ;  the  bladder  contracted  and  empty. 


196  MEDICAL   JURISPRUDENCE. 

As  regards  the  medico-legal  relations  of  starvation, 
although  it  is  rarely  the  cause  of  homicidal  death,  it  should 
be  remembered  that  the  law  does  not  require  the  absolute 
deprivation  of  food  to  be  proved,  but  only  the  necessary 
quantity  and  quality  to  be  withheld,  provided  this  has  been 
done  with  an  evil  intention.  Cases  of  this  character  are 
sometimes  witnessed  in  baby-farming. 

Death  from  poisoning  will  be  treated  at  length  in  a 
special  section  under  the  title  Toxicology. 


CHAPTER   VII. 
FEIGNED  DISEASES. 

I.  Feigned  Bodily  Diseases. — These  become  the  sub- 
ject of  inquiry  very  frequently,  especially  among  soldiers, 
sailors,  and  prisoners,  who  are  ever  ready  to  resort  to  all 
sorts  of  pretexts  to  escape  duty,  to  avoid  certain  kinds  of 
punishment,  or  to  secure  comfortable  quarters  in  a  hospital. 
Among  civilians  the  same  fraud  is  sometimes  attempted,  as 
in  an  alleged  incapacity  to  perform  military  service,  to 
undergo  imprisonment,  or  to  discharge  the  duties  of  a  juror 
or  witness.  Casper  remarks  :  This  simulation  of  disease 
is  sometimes  carried  out  by  a  purely  mental  effort,  as  by 
cunning,  lying,  or  mimicry ;  at  others,  by  the  aid  of  mate- 
rials of  various  kinds,  such  as  crutches,  bandages,  trusses, 
cutting  in.struments,  spectacles,  etc.  All  such  cases  of 
pretended  disease  are  termed  fictitious  by  Dr.  Ogston. 
There  is  another  class  of  cases  which  are  produced  by  the 
patient  at  his.  convenience,  or  at  least  are  exaggerations  of 
some  trivial  complaint ;  these  are  named  factitious  by  the 
above  author. 

The  ingenuity  of  malingerers  is  almost  incredible.  Not 
only  may  they  resort,  when  occasion  requires,  to  all  manner 
of  disgusting  performances,  such  as  swallowing  excrement 
or  blood,  or  other  offensive  substances,  but  they  may  actu- 
ally maim  or  injure  various  organs  for  the  purpose  of  gaining 
their  object.  "The  greatest  difficulty  in  detecting  impos- 
ture arises  when  we  examine  the  subjective  symptoms ;  and 
extreme  caution  is  then   needed,  besides  the  adoption  of 

197 


198  MEDICAL    JURISPRUDENCE. 

the  most  delicate  tests,  which  should  repeatedly  be  made 
use  of  until  we  are  satisfied  as  to  what  is  the  real  condition 
of  the  patient."     (Hamilton.) 

If  we  may  trust  chroniclers,  simulated  diseases  were 
much  more  common  in  former  times  than  at  present.  We 
rarely  now  note  such  extraordinary  cases  of  deception  as 
are  described  in  old  books,  of  persons  vomiting  frogs  and 
lizards  or  snakes,  passing  inky  urine,  or  discharging  im- 
mense stones  from  the  bladder,  etc.  Such  instances  of 
fraud  would  soon  be  detected  by  the  modern  means  of 
diagnosis. 

It  is  proper  that  the  physician  should  understand  the 
reasons  or  motives  of  the  malingerer  for  feigning  disease, 
since  these  may  often  aid  him  in  unmasking  the  decep- 
tion. These  motives  may  be  classed  under  the  following 
heads : 

1,  Fear. — As,  for  example,  to  avoid  military  service;  or, 
in  the  case  of  the  soldier,  to  be  excused  from  going  into 
battle.  According  to  Beck,  the  observations  of  Mr.  Lane 
on  the  modern  Egyptians  show  that  the  practice  of  break- 
ing out  one  or  more  teeth,  or  cutting  off  a  finger,  or  putting 
out  an  eye,  was  exceedingly  common  among  the  young 
men  throughout  that  country.  The  same  motive  influences 
culprits  to  escape  certain  species  of  punishment  which  they 
have  deserved,  such  as  flogging  or  the  treadmill. 

2.  Gain. —  This  is  a  very  prevalent  and  powerful  motive 
to  simulate  disease,  as,  e.  g.,  to  obtain  damages  for  some 
alleged  injury,  either  public  or  private ;  it  is  often  the 
source  of  groundless  charges  in  railway  accidents  ;  to  pro- 
cure better  quarters,  either  in  a  hospital  or  almshouse  ;  to 
obtain  a  divorce  ;  to  excite  commiseration  and  aid  from  the 
benevolent ;  and  in  numerous  other  methods. 


FEIGNED    DISEASES.  199 

3.  Laziness. — As  in  beggars  and  others,  to  escape  work 
and  live  in  idleness. 

4.  Notoriety. — This  is  chiefly  witnessed  in  hysterical 
women,  who  will  simulate  almost  every  variety  of  disease, 
and  submit  to  painful  treatment ;  who  will  frequently  muti- 
late themselves,  and  pretend  to  take  poison,  or  destroy 
themselves  in  some  other  manner,  and  with  no  other  con- 
ceivable motive  except  to  gain  notoriety. 

As  regards  the  mode  of  diagnosis,  the  following  general 
rules  may  be  observed  :  Cunning  and  shrewdness  must  be 
met  by  the  exercise  of  these  same  qualities  on  the  part  of 
the  examiner.  In  nothing  are  experience  and  tact  of  greater 
assistance  to  their  possessor  than  in  the  management  of  this 
sort  of  cases.  The  examiner  should  always  bear  in  mind 
that  simulation  may  be  possible,  and  that  this  is  likely  to  be 
practiced  in  a  given  case  if  a  sufficient  motive  exists  ;  he 
should  try  to  discover  this  motive,  using  great  caution  in 
the  attempt. 

One  should  not  be  content  with  a  single  examination  of 
the  patient,  but  should  surprise  him  with  an  unexpected 
visit,  made  soon  after  the  first  one,  and  observe  him  closely 
when  he  is  not  aware  of  notice  ;  by  this  means  the  decep- 
tion may  often  be  discovered  when  he  is  off  his  guard. 

The  patient's  account  of  the  rise  and  progress  of  his  dis- 
ease should  be  compared  with  known  medical  facts  con- 
nected with  the  history  of  the  real  disorder.  It  is  often 
useful  to  mention  in  the  patient's  hearing  certain  false 
symptoms  of  the  alleged  disease,  and  afterward  ask  him 
after  these  symptoms ;  when,  if  simulating,  he  will  be  very 
apt  to  enact  them  just  as  he  heard  them.  One  who 
complains  of  a  multitude  of  ailments  should  always  be  sus- 
pected, especially  ailments  which  have  no  natural  connec- 


200  MEDICAL   JURISPRUDENCE, 

tion  with  one  another.  All  local  ailments  should  be  exam- 
ined with  the  parts  uncovered  ;  all  dressings  and  bandages 
must  be  removed.  The  physician  should  not  be  misled  by 
cicatrices,  cupping  scars,  leech  bites,  or  blisters.  No  im- 
portance whatever  is  to  be  attached  to  the  statements  of 
relatives  or  friends,  since  they  would  naturally  sympathize 
with  the  patient. 

Anesthetics  (ether  and  chloroform)  may  sometimes  be 
employed  successfully  in  suspected  cases  of  contracture  of 
the  spine  or  muscles,  A  very  successful  method  is  to 
threaten,  and  even  use,  some  veiy  repulsive  medicine  or 
remedy,  as  powerful  revulsives,  and  especially  the  actual 
cautery  ;  but  there  are  some  cases  that  prove  obstinate  and 
unconquerable,  even  under  this  severe  ordeal. 

Special  Diagnosis. — Feigned  Pain.  —  There  is  probably 
no  symptom  so  commonly  complained  of  by  the  malingerer, 
and  none  more  difficult  to  determine  by  the  examiner,  than 
pain,  because  it  is  purely  a  subjective  symptom.  Hence,  it 
will  try  the  skill  and  tact  of  the  physician  to  the  utmost. 
A  close  and  patient  investigation  will,  however,  usually 
detect  the  fraud.  The  simulator  will  either  be  too  exactly 
correct  in  his  description  or  else  entirely  incorrect  in  his 
localization.  He  will  exhibit  great  distress  under  the 
slightest  pressure,  when  his  attention  is  directed  to  the  part ; 
but  when  this  is  directed  elsewhere,  no  evidence  of  pain  is 
manifested.  Questions  or  hints,  skillfully  thrown  out,  may 
put  him  off  his  guard  and  reveal  the  deception.  A  favorite 
seat  of  pain  is  the  back,  and  it  is  usual  among  soldiers  to 
attribute  it  to  rheumatism,  contracted  by  exposure  from 
sleeping  on  the  damp  ground.  Of  course,  there  are  some 
real  sufferers  from  this  cause,  but  they  are  outnumbered  by 


FEIGNED    DISEASES.  20I 

the  simulators.  The  latter  may  often  be  detected  by  close 
watching  when  they  think  they  are  unobserved.  Their 
agility  of  motion  contrasts  wonderfully  with  their  lameness 
and  difficulty  of  movement  when  they  come  into  court  or 
before  the  medical  officer  for  examination. 

If  the  pain  complained  of  is  very  severe  and  persistent, 
and  there  is  an  absence  of  all  other  concomitant  symptoms, 
there  is  strong  room  for  suspicion.  So,  too,  if  the  person 
complains  of  intolerable  pain  in  executing  certain  muscular 
movements,  but  evinces  no  suffering  when  exercising  the 
same  parts  in  a  way  more  in  accordance  with  his  wishes. 
"  A  young  lady,  desirous  of  escaping  her  piano  practice, 
complains  of  pain  in  one  arm  and  shoulder,  and  gains  the 
sympathy  of  her  unthinking  mother,  while  the  same  day 
she  may  devote  one  or  two  hours  to  lawn  tennis,  or  use 
her  hands  in  other  ways,  and  give  no  report  of  pain." 
(Hamilton.)  Beck  refers  to  the  case  of  a  girl  of  fifteen 
years  who,  in  order  to  be  taken  away  from  school,  com- 
plained of  severe  neuralgia  of  the  face.  On  a  subsequent 
occasion,  when  a  recurrence  of  the  pain  was  complained  of 
for  some  similar  motive,  Thompson  very  successfully  em- 
ployed a  strong  mental  remedy,  based  upon  the  known 
antipathy  she  had  to  a  dog.  He  informed  her  that  the  only 
remedy  remaining  was  to  rub  the  affected  part  over  the 
back  of  that  animal.  The  result  was  a  complete  and  imme- 
diate cure,  without  the  application  of  the  remedy. 

But,  admitting  the  frequency  of  malingering  in  the  case 
of  pain,  the  examiner  should,  on  the  other  hand,  avoid  the 
risk  of  making  a  too  hasty  diagnosis,  since  there  may  be 
cases  of  real  occult  disease  accompanied  by  pain,  and 
where  the  latter  symptom  may  be  wrongfully  attributed  to 
imposture. 
17 


202  MEDICAL   JURISPRUDENCE. 

Fever,  especially  of  the  intermittent  and  ephemeral  types, 
may  sometimes  be  cleverly  imitated.  The  heat  of  skin  and 
excitement  of  pulse  have  been  produced  by  the  use  of  stim- 
ulants, as  spirits,  cantharides,  etc.,  and  by  friction  on  the 
skin  ;  the  coating  of  the  tongue,  by  the  use  of  chalk,  pipe 
clay,  liquorice,  etc.  Dr.  Cheyne  was  sent  for  to  a  soldier 
who  was  said  to  be  in  the  chill  of  an  intermittent.  He  found 
him  shaking  violently,  but,  on  throwing  off  the  bed-clothes, 
he  was  seen,  not  in  the  cold,  but  in  the  sweating  stage,  pro- 
duced by  his  exertions. 

Pretended  Heart-disease. — Extreme  feebleness  of  the  pulse 
has  been  produced  by  ligatures  around  the  arm,  by  pres- 
sure upon  the  axillary  artery,  and,  in  certain  individuals,  by 
taking  a  deep  inspiration  and  suspending  the  breathing. 
The  case  of  Col.  Townshend,  reported  by  Cheyne,  was  of  a 
similar  character,  where  there  was  a  voluntary  suspension 
of  the  heart's  action  for  a  limited  period.  Palpitation  may 
be  excited  by  the  internal  use  of  various  drugs,  as  tobacco, 
digitalis,  and  American  hellebore  ;  also  by  introducing  these 
substances  into  the  rectum.  The  stethoscope  should  be 
used  in  all  suspected  cases. 

Feigned  Pulmonary  Ttiberadosis. — This  disease  has  been 
simulated  by  coughing  and  by  producing  emaciation  by 
abstinence  and  the  use  of  vinegar  ;  by  pricking  the  gums  or 
fauces  and  spitting  up  blood ;  by  mixing  the  sputa  of 
ordinary  catarrh  with  pus  and  blood,  etc.  A  careful  stetho- 
scopic  examination  will  usually  detect  the  imposture  ;  but 
the  examination  of  the  sputa  for  the  specific  bacillus  will  be 
the  most  satisfactory  text.  Foreign  blood  may  also  be  dis- 
covered by  the  microscope.  Hematemesis  has  been  imitated 
by  the  patient  swallowing  blood  and  then  throwing  it  up 
in  the  presence  of  spectators.      Casper  mentions  a  case  of  a 


FEIGNED    DISEASES.  203 

woman  who  exhibited  a  bloody  handkerchief  as  an  evidence 
of  her  having  vomited  blood,  but  which,  on  microscopic 
examination,  proved  to  be  the  blood  of  a  bird.  Hematuria 
has  been  feigned  by  mixing  blood  with  the  urine  or  by 
using  substances  that  have  the  power  of  reddening  this 
secretion.  The  suspected  patient  should  always  be  made 
to  urinate  in  the  presence  of  the  examiner,  and  the  urine  be 
properly  examined  for  blood. 

Feigned  Incontinence  of  Urine.  —  This  is  frequently  prac- 
tised by  soldiers  in  order  to  get  into  a  hospital.  A  good 
plan  to  detect  the  imposture  is  to  give  an  opiate  at  night, 
and  introduce  the  catheter  during  his  sleep  ;  or  by  taking 
him  by  surprise  during  the  day,  and  introducing  the  instru- 
ment, when  it  will  be  found  that  the  urine  has  not  drained  off 
drop  by  drop  as  it  was  secreted,  but  that  the  bladder  pos- 
sesses the  power  of  retention.  If  the  disease  is  real,  the  pre- 
puce and  glans  penis  are  found  to  be  pale,  from  its  continu- 
ance, and  always  moist ;  and  the  clothes  exhale  a  urinous  odor. 

Feigned  Epilepsy. — This  disease  is  very  frequently  simu- 
lated, probably  for  the  reason  of  the  pity  and  affright  that 
it  is  apt  to  inspire  ;  and  also  on  account  of  the  short  dura- 
tion of  the  paroxysm  and  the  length  of  the  interval  during 
which  the  patient  may  enjoy  his  Hberty.  Impostors  affect 
the  most  violent  forms  of  the  disorder,  suddenly  falling 
down  in  convenient  places,  and  writhing  in  great  contor- 
tions ;  they  thus  are  apt  to  overdo  it.  Many  cases  may  be 
unmasked  by  threats,  or  by  applying  a  strong  faradic  cur- 
rent, or  the  actual  cautery.  But  instances  are  related  where 
the  impostor  has  suffered  all  manner  of  injury  rather  than 
confess,  and  the  noted  Clegg,  "  the  dummy  clincher,"  threw 
himself,  in  one  of  his  pretended  paroxysms,  from  a  corridor 
to  the  floor,  a  distance  of  nearly  twenty  feet. 


204  MEDICAL   JURISPRUDENCE. 

Sometimes  the  impostor  will  produce  frothing  at  the 
mouth  by  inserting  a  piece  of  soap  behind  the  cheek.  In 
suspected  cases  it  is,  therefore,  well  to  examine  the  mouth. 
If  closely  watched,  the  malingerer  may  be  observed  to  look 
about  him,  or  to  show  some  interest  in  the  result  of  his 
actions.  In  real  epilepsy,  there  is  an  entire  loss  of  con- 
sciousness, and  also  of  sensation  to  the  severest  applica- 
tions. DeHaen  relates  the  case  of  a  beggar  in  Paris,  who 
often  fell  in  the  streets.  A  bed  of  straw  was  prepared, 
through  compassion,  on  which  he  might  be  laid,  to  pre- 
vent injury  to  himself  When  next  attacked,  he  was  laid 
on  it,  and  the  four  corners  set  on  fire.  He  sprang  up 
and  fled. 

The  best  plan  is  for  the  examiner  to  be  fully  acquainted 
with  the  phenomena  and  signs  of  the  genuine  disease,  so 
as  to  be  able  to  compare  them  with  the  feigned.  In  true 
epilepsy  the  patient  falls  forward,  and  as  he  falls  he  is  very 
pale  ;  during  the  convulsion,  the  features  are  turgid  and 
livid  ;  the  veins  of  the  neck  swollen  ;  the  pupils  dilated  and 
insensible  to  light ;  the  hands  clenched,  with  the  thumbs 
closed  within  the  hands.  If  the  hands  be  forced  open, 
they  remain  relaxed,  whereas  in  the  feigned,  they  imme- 
diately close  again.  The  muscular  rigidity  is  simultaneous 
over  the  whole  body ;  nor  is  there  any  regular  period  for 
the  return  of  the  fits.  Thus,  a  simulated  case  was  detected 
by  the  surgeon  stating  in  his  hearing  that  the  real  disease 
always  came  on  in  the  morning ;  he  swallowed  the  bait, 
and  the  subsequent  attacks  always  occurred  before  noon. 
In  the  real  disease,  the  sense  of  smell  is  entirely  abolished. 
Occasionally  there  may  be  hemiplegia.  The  urine,  feces, 
and  semen  may  often  be  discharged  during  the  paroxysm. 
Ecchymoses  are  sometimes  found  on  the  shoulders  after  a 


FEIGNED    DISEASES.  205 

fit ;  and  bruises  and  other  injuries  may  sometimes  be  met 
with,  as  results  of  the  fall. 

Beck  mentions  another  fact  that  should  be  remembered, 
namely,  that  the  real  epileptic  is  desirous  of  concealing  his 
situation,  through  a  sort  of  false  shame,  whilst  the  pre- 
tender talks  about  the  disease,  and  apparently  delights  in 
publicity.  In  the  feigned,  the  glottis  is  not  closed,  and 
respiration,  though  impeded,  is  not  interrupted  ;  nor  does 
the  face  become  so  swollen  or  livid  as  in  the  real. 

Feigned  Paralysis. —  This  disease  is  frequently  simulated, 
usually  in  a  single  limb,  but  sometimes  in  both  the  upper 
or  the  lower  extremities.  In  such  cases  it  will  be  found 
that  there  is  usually  more  or  less  rigidity ;  that  there  is  no 
atrophy,  as  in  the  real,  and  that  the  electric  currents  will 
produce  their  usual  reactions.  The  sensation  and  reflex 
movements,  moreover,  are  not  lost. 

One  of  the  most  efficient  means  of  detecting  the  impostor 
is  to  administer  a  severe  electric  shock.  Suddenly  and 
unexpectedly  seizing  the  paralyzed  limb  will  sometimes 
discover  the  fraud,  by  the  patient  exerting  his  strength  to 
prevent  the  raising  of  the  limb. 

Hutchinson  administered  to  one  who  pretended  to  have 
paralysis  of  his  right  arm  a  large  dose  of  laudanum  secretly, 
in  his  tea,  and  when  he  was  sound  asleep  he  tickled  his 
right  ear  with  a  feather,  when  instantly  the  lame  hand  was 
raised.  In  some  cases  the  pretense  may  be  unmasked  by 
the  use  of  anesthetics  ;  and  in  one  of  paralysis  of  the  legs 
reported  by  Marshall,  after  every  attempt  to  discover  the 
fraud  had  failed,  it  was  finally  brought  out  by  rubbing 
cowhage  {Dolichos  pruriens)  on  the  soles  of  the  feet,  at  bed- 
time. He  walked  and  groaned  all  night,  and  the  next 
morning  reported  himself  fit  for  duty. 


206  MEDICAL   JURISPRUDENCE. 

Feigned  Unconsciousness ,  Trance,  Catalepsy  and  Soinnam- 
bulisju.  —  These  different  nervous  conditions  may  all  be 
simulated,  where  there  is  sufficient  motive ;  but  careful 
watching  and  study  of  the  cases  will  usually  succeed  in 
detecting  the  imposture. 

One  of  the  most  remarkable  cases  of  feigned  uncon- 
sciousness is  that  of  Phineas  Adams.  This  man  was  a 
soldier  and  was  .imprisoned  for  desertion.  He  remained 
apparently  unconscious  for  over  two  months,  in  spite  of  the 
most  powerful  applications  in  the  form  of  revulsives,  even 
to  the  cutting  down  through  the  scalp  upon  the  skull.  As 
his  case  was  considered  hopeless  he  was  discharged,  and  in 
a  couple  of  days  he  was  seen  perfectly  restored,  and  assist- 
ing his  father  in  thatching  a  rick. 

Feigned  Diseases  of  the  Eye.  —  Ophthalmia  is  artificially 
produced  by  the  introduction  of  irritants  into  the  eye.  It 
is,  however,  detected  by  the  rapidity  of  its  progress,  arriving 
at  its  height  within  a  few  hours  after  the  application  of  the 
irritant.  In  soldiers,  sometimes  only  one  eye  is  affected, 
and  almost  uniformly  the  right  one  —  the  one  with  which 
he  takes  aim.  A  left-handed  man  would  probably  inflict 
the  injury  on  the  left  eye. 

It  is  sometimes  difficult  to  detect  cases  of  blindness 
arising  from  amaurosis.  In  this  disease  the  pupil  is  usually 
dilated  and  fixed,  but  there  are  instances  in  which  it  retains 
some  contractile  power.  The  patient  should  be  carefully 
watched  to  see  whether  he  avoids  obstacles  placed  in  his 
way.  If  the  pupil  contracts  perfectly,  there  is  no  doubt 
about  the  case  being  feigned.  The  dilated,  immovable 
pupil  may  be  imitated  by  the  use  of  belladonna  or  other 
mydriatics. 

Feigned  Deafness  may  often  be  detected  by  making  a 


FEIGNED    btSEASES.  20/ 

noise  at  an  unexpected  moment,  such  as  dropping  a  piece  of 
metal ;  he  will  be  very  apt  to  turn  his  head  in  the  direction 
from  whence  the  noise  proceeded.  The  suspected  person 
should  be  taken  unawares,  the  tone  of  the  examiner's  voice 
should  be  changed  ;  his  countenance  should  be  watched 
while  something  in  which  he  is  personally  interested  is 
being  related  to  him,  A  deaf  person  usually  converses  in 
a  low  tone  of  voice. 

Dunlap  mentions  the  case  of  a  soldier  who  pretended 
deafness  so  well  that  firing  a  pistol  at  his  ear  produced  no 
effect ;  but  on  trying  the  experiment  after  he  had  been  put 
to  sleep  by  opium,  he  started  up  out  of  bed. 

Pretended  Deaf-mutism  is  more  difficult  to  maintain  than 
pretended  deafness.  The  best  plan,  in  order  to  detect  the 
imposture,  is  to  say  something  that  deeply  interests  the 
patient,  and  watch  the  physiognomy.  Notice  also  if  a 
body  let  fall  near  the  person  will,  by  its  vibrations,  cause  him 
to  look  around.  The  application  of  a  strong  faradic  current 
over  the  larynx  will  sometimes  succeed  in  detecting  the 
fraud. 

The  case  of  Victor  Travanait  illustrates  the  ingenuity 
and  perseverance  of  some  of  these  cases.  This  young  man 
succeeded  for  four  years  in  eluding  the  closest  scrutiny 
exercised  upon  him  throughout  Europe ;  he  was,  however, 
at  last  discovered  by  the  celebrated  Sicard,  of  Paris. 

Fictitious  Tumors  and  Enlargements. — These  are  generally 
feigned  by  impostors  for  the  purpose  of  exciting  sympathy 
and  material  aid.  Hydrocephalus  in  children,  and  local 
dropsy  in  both  children  and  adults,  and  simulated  by  blow- 
ing up  the  cellular  tissues  under  the  skin,  and  by  ligatures 
on  various  parts  of  the  body.  Mahon  relates  the  case  of  a 
young  woman  of  Strasburg,  whose  abdomen  commenced 


208  MEDICAL   JURISPRUDENCE. 

to  swell,  and  continued  to  do  so  for  thirty-nine  years,  by 
which  means  she  excited  the  commiseration  and  charity  of 
all  who  saw  her,  and  by  which  she  procured  a  comfortable 
support.  At  her  death,  in  place  of  the  supposed  tumor, 
there  was  found  merely  an  enormous  sack  or  cushion, 
which  she  had  habitually  worn  over  her  abdomen.  She 
never  would  consent  to  a  medical  examination  for  obvious 
reasons. 

Pretended  or  Factitious  IVoimds,  or  voluntary  mutilations, 
are  inflicted  for  various  purposes,  as  for  attracting  sym- 
pathy, or  cloaking  some  criminal  act  that  may  have  been 
committed.  Mutilation  of  the  thumb  was  common  among 
the  conscripts  of  ancient  Rome,  and  it  is  stated  to  be  quite 
a  common  practice  among  soldiers,  during  modern  wars,  to 
inflict  similar  injuries  upon  themselves,  either  by  fire-arms 
or  by  cutting  instruments. 

The  case  of  Whittaker,  the  colored  West  Point  cadet, 
affords  an  illustration  of  self-inflicted  wounds,  along  with  an 
affected  unconsciousness,  for  the  purpose  of  carrying  out  a 
certain  scheme.  This  youth  had  repeatedly  failed  in  his 
studies  ;  and  upon  the  eve  of  his  examination,  which  would 
most  probably  have  resulted  in  his  suspension,  he  made  a 
desperate  attempt  to  excite  the  sympathy  of  the  community, 
as  well  as  to  gain  time  for  study.  One  morning  he  was 
found  in  his  sleeping  room,  apparently  unconscious,  and 
tied  to  his  bed  with  strips  of  muslin.  There  were  several 
slight  cuts,  one  on  the  ear  and  another  across  the  toe.  He 
continued  apparently  unconscious  of  all  surroundings  for 
some  time,  when  he  opened  his  eyes  in  a  stupid  condition. 
His  story  was  that  he  had  been  surprised  several  hours 
before  by  a  band  of  masked  men,  who  felled  him  to  the 
floor,  and  who,  after  wounding  and  threatening  him  left  the 


FEIGNED    WOUNDS.  2O9 

room.  Numerous  circumstances  showed  that  the  whole 
thing  was  an  imposture,  and  on  trial  he  was  found  guilty, 
but  his  sentence  was  modified. 

Another  case  was  that  of  a  bank  cashier,  who  was  found 
gagged  and  tied,  and  wounded  in  a  superficial  manner, 
while  at  the  same  time  the  funds  of  the  bank  were  missing. 
It  was  afterward  discovered  that  the  wounds  were  self- 
inflicted,  and  that  other  preparations  were  made  for  the 
purpose  of  diverting  suspicion  from  himself. 

In  cases  of  this  character,  one  very  suspicious  circum- 
stance is  that  the  wounds  are  always  superficial,  and  not 
of  a  dangerous  character ;  they  are  usually  mere  cuts  or 
scratches,  not  involving  any  vital  parts.  Moreover,  the 
cuts  or  stabs  made  in  the  garments  will  often  be  found  not 
to  correspond  with  those  made  on  the  body.  It  sometimes 
happens  that  slight  and  trivial  injuries  received  in  a  railway 
or  other  collision  are  magnified  purposely,  in  order  to 
obtain  larger  damages  in  a  suit  at  law.  Again,  persons  who 
have  unsuccessfully  attempted  to  commit  suicide  are  apt, 
from  motives  of  shame  or  disappointment,  to  attribute  their 
wounds  to  another.  In  such  cases,  the  injuries  are  super- 
ficial, made  usually  by  the  right  hand  and  in  front,  while 
the  hands  themselves  are  seldom  wounded  ;  in  a  real  assault 
the  hands  are  very  apt  to  be  cut  and  maimed. 

Feigned  Pregnancy  and  Delivery  will  be  hereafter  con- 
sidered. 

II.  Feigned  Mental  Disorders  will  be  discussed  under 
the  head  of  Insanity. 


CHAPTER  VIII. 
PREGNANCY. 

The  occasions  in  which  Pregnancy  becomes  the  subject 
of  medico-legal  inqury  are  the  following:  (i)  A  woman 
may  declare  herself  pregnant  with  an  heir  to  an  estate,  for 
the  purpose  of  defrauding  other  heirs-at-law  ;  (2)  for  the 
purpose  of  extorting  money  from  a  seducer  or  paramour; 
(3)  to  stay  the  infliction  of  capital  punishment  until  after 
delivery ;  (4)  the  plea  of  pregnancy  may  be  set  up  as  an 
excuse  for  non-attendance  at  a  trial  to  awaken  sympathy, 
etc. ;  (5)  an  accusation  of  pregnancy  may  be  made  against 
a  single  woman,  or  one  living  apart  from  her  husband, 
which  may  result  in  an  action  for  damages  for  slander ;  (6) 
accusations  of  malpractice  may  be  made  against  a  medical 
man  for  error  in  diagnosis  of  pregnancy,  or  an  attempt  to 
bring  on  an  abortion. 

On  the  other  hand,  pregnancy  may  be  concealed  (i)  in 
order  to  procure  abortion  or  infanticide ;  (2)  in  order  to 
avoid  disgrace. 

The  Roman  law  exempted  a  pregnant  female  from  capital 
punishment  until  after  delivery.  The  laws  of  most  modern 
countries  follow  the  Roman  custom  in  this  matter.  By  the 
old  English  law,  under  the  writ  of  de  ventre  inspiciendo, 
"  a  jury  of  twelve  matrons,  or  discrete  women,"  was  sum- 
moned to  ascertain  the  fact  of  pregnancy  in  the  civil  case, 
and  the  further  fact  of  the  woman's  being  "quick  with 
child,"  in  a  criminal  accusation.  In  Scotland,  the  preg- 
nancy simply  must  be  proved  without  reference  to  quicken- 


SIGNS    OF    PREGNANCY.  211 

ing,  and  without  the  jury  of  matrons.  At  the  present  day, 
both  in  England  and  in  our  own  country,  the  jury  of 
matrons  has  been  very  properly  superseded  by  a  jury  of 
instructed  physicians. 

To  enable  the  physician  to  decide  upon  the  fact  of  preg- 
nancy, he  must  necessarily  be  acquainted  with  its  signs. 
These  may  be  described  under  the  heads  of  (i)  the  uncer- 
tain and  (2)  the  certain,  or  positive,  signs. 

I.    Uncertain  Signs. — These  comprise  the  following  : 

{a)  Stippression  of  the  Catamenia.  —  This  may  be  regarded 
as  a  probable  sign  of  pregnancy  if  it  occurs  in  a  woman 
who  was  always  regular,  and  if  at  the  end  of  three  months 
she  recovers  her  usual  health  without  reestablishment  of 
the  function ;  since,  if  the  suppression  were  the  result  of 
disease,  a  general  and  continued  loss  of  health  would  be  apt 
to  follow.  But  there  are  many  exceptions, — as  when  the 
menses  are  suppressed,  temporarily,  by  disease  ;  when  men- 
struation continues  throughout  pregnancy ;  when  it  has 
never  occurred  in  the  woman  at  all,  and  yet  she  has  given 
birth  to  several  children  and  continued  in  good  health  ;  and 
when  the  catamenia  have  appeared  only  during  pregnancy, 
but  were  absent  at  other  times. 

In  cases  of  concealed  pregnancy,  the  woman  may  stain 
her  linen  with  blood  (and  even  with  borrowed  menstrual 
blood)  for  the  purpose  of  imitating  menstruation.  This 
deception  may  generally  be  detected  by  close  watching, 
and  still  more  accurately  by  a  microscopic  examination  of 
the  suspected  stains.  Menstrual  blood  does  not  coagulate 
so  readily  as  ordinary  human  blood,  on  account  of  the 
vaginal  mucus.  It  also  contains  epithelium  scales,  easily 
recognized  by  the  microscope. 

Uj)  Morning  Sickness.  —  Nausea  is  very  apt  to  be  an  early 


212  MEDICAL   JURISPRUDENCE. 

accompaniment  of  pregnancy,  sometimes  as  early  as  the 
second  or  third  week  after  conception.  It  usually  ceases 
after  quickening,  but  it  may  continue  throughout  the  whole 
period  as  a  most  distressing  symptom.  There  are  many 
cases,  however,  where  it  does  not  occur ;  and  it  is  also  an 
uncertain  sign  of  pregnancy,  because  nausea  accompanies 
many  diseases. 

[c)  Enlargement  of  the  Abdomen.  —  In  pregnancy,  the  en- 
largement of  the  abdomen  begins  to  be  obvious  after  the 
end  of  the  third  month,  when  the  uterus  rises  out  of  the 
cavity  of  the  pelvis.  At  about  the  fifth  month,  it  is  midway 
between  the  pelvis  and  umbilicus,  which  latter  it  reaches 
at  the  end  of  the  sixth  month.  During  the  seventh  month, 
it  reaches  half  way  between  the  umbilicus  and  the  ensiform 
cartilage ;  at  the  end  of  the  eighth  month,  it  is  on  a  level 
with  this  cartilage.  During  the  ninth  month,  it  does  not 
ascend  higher,  but  the  tumor  widens  somewhat  and  falls 
slightly  forward. 

This  sign  is  subject  to  many  fallacies  :  the  enlargement 
may  proceed  from  ascites,  ovarian  dropsy,  ovarian  tumor, 
retained  catamenia,  flatus  of  the  intestines,  impacted  feces, 
excess  of  fat,  distention  of  the  bladder,  and  enlargement  of 
spleen  and  kidney.  Great  caution  is  necessary  in  order  to 
make  a  diagnosis ;  mistakes  have  been  made  even  by  expe- 
rienced examiners.  Intestinal  flatus  may  be  distinguished 
by  percussion ;  the  presence  of  fluid  (ascites  and  ovarian 
dropsy),  by  palpation  ;  ovarian  enlargement,  by  its  history 
and  progress.  In  true  pregnancy,  after  the  seventh  month, 
the  tumor  will  sensibly  contract  under  the  cold  hand,  and 
the  fetal  movements  may  be  distinctly  felt.  The  outlines 
of  the  fetus  also  can  often  be  felt.  A  dark  line  extending 
from  the  umbilicus  to  the  pubis  may  also  generally  be  dis- 


SIGNS    OF    PREGNANCY.  21 3 

tinguished  ;    but  this  may  date  from  a  previous  pregnancy, 
and  also  may  accompany  ovarian  enlargement. 

The  enlargement  of  the  abdomen  may  lead  to  unfounded 
suspicions  reflecting  upon  the  reputation  and  happiness  of 
the  female.  In  certain  puzzling  cases,  in  which  the  enlarge- 
ment is  accompanied  by  subjective  signs  on  the  part  of  the 
woman,  simulating  the  movements  of  the  child,  it  may  be 
traced  to  accumulation  of  flatus  in  the  intestines,  accom- 
panied by  contraction  of  the  abdominal  muscles,  constituting 
a  phantom  tumor ;  this  condition  is  best  cleared  up  by 
placing  the  woman  under  ether,  when  the  enlargement  will 
be  found  to  subside. 

(^d)  Quickening.  —  By  this  term  is  understood  the  first 
perception  by  the  mother  of  the  movements  of  the  fetus. 
Its  usual  time  of  occurrence  is  from  about  the  sixteenth  to 
the  twenty-fourth  week  —  sometimes  earlier,  sometimes  later. 
It  may  often  be  absent  altogether,  even  when  a  healthy 
child  is  born.  Its  cause  is  ascribed  either  to  the  rising  of 
the  uterus  out  of  the  cavity  of  the  pelvis,  or  to  the  increased 
activity  of  the  fetus,  or  to  the  latter  now  coming  in  contact 
with  the  uterine  walls.  However  produced,  it  is  a  very 
deceptive  sign  of  pregnancy,  as  it  is  purely  a  subjective 
symptom,  and  many  nervous  women,  especially  when 
anxious  to  have  children,  will  mistake  movements  of  the 
intestines  and  the  contraction  of  the  abdominal  muscles  for 
the  motions  of  a  child. 

{e)  Development  of  the  Breasts.  —  As  a  general  rule,  during 
the  progress  of  pregnancy,  the  breasts  become  larger,  fuller, 
more  knotty,  and  tender  to  the  touch  ;  enlarged  veins  course 
along  the  surface  ;  the  nipples  and  the  surrounding  follicles 
become  more  prominent ;  the  areola  widens  and  assumes 
a  darker   hue,  especially  observable   in   brunettes.      In  fair 


214  MEDICAL   JURISPRUDENCE. 

women,  these  changes  are  often  not  noticeable.  Besides, 
enlargement  of  the  breasts  often  occurs  in  suppression  of 
the  menses,  in  uterine  fibroids,  and  in  ovarian  and  uterine 
disorders.  An  excessive  adipose  secretion  around  the 
breasts  is  liable  to  be  confounded  with  a  true  enlargement 
of  the  mammary  gland. 

The  increased  development  of  the  breasts,  being  due  to 
the  secretion  of  milk,  is  more  observable  towards  the  end 
of  the  pregnancy,  when,  frequently,  this  secretion  is  mani- 
fested. 

The  presence  of  milk  in  the  mammary  gland  is  no  proof 
of  pregnancy,  since  it  has  frequently  been  seen  in  the 
unimpregnated  female,  and  even  in  young  girls.  Dr.  E. 
Warren,  of  North  Carolina,  relates  an  instance  of  a  woman, 
aged  fifty-five  years,  whose  catamenia  had  ceased,  and  who 
was  in  poor  health,  when  she  undertook  to  bring  up  the 
child  of  a  deceased  friend.  To  keep  it  quiet  at  night,  she 
was  accustomed  to  put  it  to  the  breast.  In  six  months  the 
secretion  of  milk  was  perfectly  established,  and  she  con- 
tinued to  nurse  it  for  twelve  months,  the  child  becoming 
healthy  and  strong.-  Still  more  remarkable  are  the  cases 
of  secretion  in  the  breasts  of  males.  DungHson  relates  the 
case  of  a  man  aged  fifty-five  years,  who  performed  the  office 
of  wet  nurse  for  several  years. 

(y)  TJie  violet  color  of  the  vagina,  due  to  venous  conges- 
tion (Jacquemin's  test),  commencing  about  the  fourth  week. 
This  is  considered  by  Montgomery  and  others,  as  a  very 
certain  sign  of  pregnancy,  though  its  absence  is  not  to  be 
accepted  as  a  negative  proof  Dr.  R.  Barnes  regards  the 
flattening  of  the  upper  wall  of  the  vagina  as  a  reliable  sign 
of  pregnancy  in  the  early  months.  It  is  attributed  to  the 
enlargement  of  the  womb  with  slight  anteversion,  throwing 


SIGNS    OF    PREGNANCY.  215 

the  OS  backward,  and  rendering  the  superior  wall  of  the 
vagina  tense. 

II.    Certain,  or  Positive,  Signs : — 

(«)  Bal/ottement.  —  This  test  will  determine  the  presence 
of  a  fetus  (or  some  floating  body)  in  the  liquor  amnii,  as 
early  as  the  fifth  or  sixth  month  of  pregnancy.  It  is  prac- 
tised by  causing  the  woman  to  stand  upright,  and  introduc- 
ing a  finger  into  the  vagina  up  to  the  mouth  of  the  womb, 
while  the  other  hand  is  placed  over  the  abdomen,  so  as  to 
steady  the  uterine  tumor.  If  the  tip  of  the  finger  is  now 
suddenly  jerked  upward  against  the  os,  a  sensation  will  be 
imparted  to  it  as  from  a  body  floating  upward  in  a  liquid, 
and  falling  back  again  to  strike  the  finger.  It  is  stated  that 
floating  tumors  of  the  uterus,  attached  to  its  walls  by  a 
pellicle,  may  produce  the  same  sensation  to  the  finger. 

(^)  Change  i?i  the  Body  and  Cervix  of  the  Uterus.  —  The 
shortening  of  the  cervix  is  perceptible  to  the  touch  after  the 
fifth  month  ;  the  os  uteri  is  directed  more  backward,  and 
there  is  a  peculiar  velvety  feel  about  it.  The  neck  con- 
tinues to  shorten  until  the  ninth  month,  when  it  becomes 
obliterated,  having  been  absorbed  into  the  body  of  the 
womb.  The  feel  of  the  os  in  the  unimpregnated  and  in  the 
pregnant  state  is  different ;  in  the  latter,  it  is  more  patulous 
than  in  the  former. 

(c)  The  Active  Motions  of  the  Child.  —  These  can  rarely  be 
distinguished  before  the  fifth  month,  after  which  they  usually 
increase  in  strength,  progressively.  They  are  manifested  by 
placing  the  cold  hand  upon  the  surface  of  the  abdomen. 
These  movements  should  not  be  confounded  with  intestinal 
movements  caused  by  the  escape  of  flatus  from  one  portion 
of  the  bowels  into  another.  Cases  often  occur  in  which  the 
active  motions  of  the  child  are  scarcely  perceptible. 


2l6  MEDICAL   JURISPRUDENCE. 

(d)  Pulsation  of  the  Fetal  Heart. — This  is  an  unequivocal 
proof  of  pregnancy,  when  it  can  be  positively  and  repeatedly 
determined.  The  sound  resembles  the  ticking  of  a  watch  ; 
it  is  a  double  sound,  not  synchronous  with  the  mother's 
pulse,  and  counting  from  150  to  120  a  minute,  according 
as  pregnancy  advances.  It  is  heard  over  different  parts  of 
the  abdomen,  but  preferably  between  the  ilium  and  the 
umbilicus,  on  either  side.  At  times  it  may  be  inaudible, 
owing  to  a  change  in  the  position  of  the  child.  This  sound 
may  often  be  heard  as  early  as  the  fifth  month,  but  it  be- 
comes more  distinct  as  pregnancy  advances. 

{e)  Other  Fetal  Sounds. — These  are  the  Uterine  and  Um- 
bilical Souffle.  The  first  is  a  peculiar  blowing  or  whistling 
sound,  audible  over  most  of  the  abdomen,  and  beheved  to 
be  due  to  the  passage  of  the  blood  through  the  uterine 
arteries,  or  the  placental  vessels.  It  is  synchronous  with 
the  pulse  of  the  mother.  It  can  be  perceived  as  early  as 
the  tenth  week,  but  better  at  a  later  period,  up  to  the  end 
of  the  seventh  month.  It  is  not  an  important  sign  of  preg- 
nancy, inasmuch  as  it  may  be  heard  in  enlargement  of  the 
uterus  from  any  cause,  as  by  tumors,  etc. 

The  second  or  Umbilical  sound  is  attributed  to  the  circu- 
lation through  the  umbilical  vessels.  It  is  more  difficult  to 
distinguish  than  the  other  sound,  and  is  of  little  diagnostic 
importance.  It  is  a  single  bellows  murmur,  synchronous 
with  the  pulsations  of  the  fetal  heart,  and  is  heard  over  a 
very  limited  space,  and  is  best  distinguished  in  cases  where 
the  cord  is  wound  round  the  body  of  the  child.  With  all 
the  above  signs  at  command,  it  is  safer  not  to  give  a  posi- 
tive opinion  in  a  case  of  suspected  pregnancy  before  the 
sixth  month. 

The  Corpus  Luteuni.  —  The  value  of  the  corpus  luteum 


SIGNS    OF    PREGNANCY.  21/ 

or  the  stellated  cicatrix,  as  a  diagnostic  sign  of  pregnancy, 
is  materially  lessened  by  the  well-ascertained  fact  that  a 
similar  body  is  formed  in  the  ovary  after  each  menstrual 
flow,  or,  more  correctly  speaking,  after  each  discharge  of 
a  ripened  ovum.  The  latter  is  usually  termed  a  false  corpus 
luteum,  and  it  differs  from  the  true  corpus  luteum  of  preg- 
nancy in  certain  particulars,  such  as  the  shorter  duration, 
the  less  complete  development  of  the  stellate  structure  and 
yellow  color,  and  the  absence  of  a  central  cavity.  This  is 
the  general  rule  ;  and  the  reason  usually  assigned  for  the 
increased  growth  and  development  of  the  corpus  luteum 
of  pregnancy  is  the  increased  nutrition  derived  by  the 
Graafian  follicle,  through  the  stimulus  of  impregnation. 

The  value  of  this  "sign"  is  still  further  lessened  by 
the  fact  that  a  corpus  luteum  has  been  found  when  there 
has  been  neither  pregnancy  nor  menstruation.  Tidy  cites 
two  illustrations  of  this  last  character ;  one,  that  of  a 
prostitute  who  was  poisoned  by  hydrogen  cyanid,  when 
neither  pregnant  nor  menstruating,  and  in  whom  a  fully- 
ripe  corpus  luteum  was  found  after  death.  The  other,  a 
woman  who  died,  aged  forty-one,  from  gangrene  of  a  uterine 
fibroid ;  the  ovary  contained  a  perfectly  formed  corpus 
luteum,  resembling  that  of  pregnancy.  In  both  these  cases 
the  author  very  properly  ascribes  the  abnormal  development 
to  the  increased  determination  of  blood  to  the  part ;  his 
conclusion  being,  that  "there  may  be  pregnancy  without 
the  presence  of  a  true  corpus  luteum,  and  also  that  bodies 
undistinguishable  from  true  corpora  lutea  may  be  found 
where  there  has  been  no  pregnancy,  and  in  aged  women 
long  past  the  period  when  pregnancy  was  probable. 

Instances  of  precocious  pregnancy  are  mentioned  by 
various  writers,  occurring  as  early  as  in  the  eleventh  and 


2l8  MEDICAL   JURISPRUDENCE. 

twelfth  years,  among  the  women  of  India  and  Abyssinia, 
and  occasionally  even  in  temperate  climates.  The  earliest 
period  of  pregnancy  that  we  find  recorded  is  mentioned 
by  Tidy,  as  given  by  Mr.  Lefevre,  of  a  girl  who  menstru- 
ated at  four  years,  and  became  pregnant  at  eight  years. 
Another  case  is  recorded  in  which  pregnancy  occurred  at 
eight  years  and  ten  months,  and  the  child  at  birth  weighed 
seven  pounds.  In  another  instance,  quoted  by  Wharton, 
and  Stille,  menstruation  commenced  in  the  first  year,  and 
pregnancy  in  the  ninth.  The  child  at  birth  weighed  seven 
and  three  quarter  pounds. 

Instances  of  late  pregnancy  are  recorded,  often  as  late  as 
fifty  years  ;  and  a  case  of  twins  at  sixty-four  years. 

The  question  whether  a  woman  may  become  pregnant 
unconsciously  must  be  answered  affirmatively.  Women 
are  not  infrequently  raped  when  in  an  unconscious  state 
through  narcotism,  or  the  anesthesia  produced  by  ether  or 
chloroform ;  and  pregnancy  may  result  from  such  ah  inter- 
course, as  is  well  known,  but  that  a  woman  should  be 
unconscious  both  of  the  fact  of  sexual  intercourse,  and  also 
continue  unconscious  of  the  resulting  pregnancy  up  to  the 
birth  of  her  child,  can  scarcely  be  believed,  unless  she  is 
feeble-minded  or  idiotic.  Cases  of  this  character  may  occur 
in  unmarried  women,  who  may  protest  most  earnestly 
their  utter  ignorance  of  the  whole  affair,  and  pretend  to 
ascribe  the  pangs  of  labor  to  colic  or  some  other  disorder  ; 
and  who,  when  the  child  is  shown  them,  may  positively 
deny  all  knowledge  of  its  origin. 

With  married  women  the  case  is  quite  different.  With 
them  unconscious  pregnancy  is  a  very  possible  occurrence. 
Many  instances  might  be  adduced  of  married  women  who, 
having  had  no    children   for    several  years,  on  becoming 


PREGNANCY    IN    THE    DEAD.  2I9 

actually  pregnant,  refused  to  recognize  their  true  condition, 
ascribing  their  increase  of  size  to  dropsy,  or  some  other 
disorder. 

Cases  may  occur  when  it  may  become  necessary  to  ascer- 
tain the  fact  of  pregnancy  in  the  dead,  as,  e.g.,  to  determine 
the  identity  of  a  body,  and  to  rescue  the  reputation  of  the 
deceased  from  the  charge  of  unchastity.  It  should  be 
remembered  that  the  unimpregnated  uterus  resists  putre- 
faction longer  than  any  other  organ  of  the  body.  Casper 
mentions  the  case  of  a  young  woman  whose  body  was 
found,  nine  months  after  her  disappearance,  in  a  privy,  so 
decomposed  that  the  soft  parts  separated  easily  from  the 
bones,  but  the  uterus  which  was  firm  when  examined,  proved 
to  be  in  the  unimpregnated  state.  This  circumstance  was  of 
the  greatest  consequence,  as  it  served  to  rebut  the  charge 
of  seduction  and  murder  against  a  young  man,  who  had 
been  suspected  of  foul  play. 

On  the  other  hand,  the  discovery  of  a  fetus  (or  a  mole) 
in  the  uterus  of  the  deceased  is,  of  course,  decisive  proof 
of  pregnancy  ;  and  even  years  after  interment,  provided  the 
fetus  has  reached  the  period  of  ossification,  traces  of  its 
bones  may  be  discovered  among  the  bones  of  the  mother. 


CHAPTER  IX. 
CRIMINAL  ABORTION,  OR  FETICIDE. 

Criminal  Abortion  is  the  unlawful  producing  the  expul- 
sion, and  consequent  destruction,  of  the  fetus  (usually  im- 
mature) from  the  womb  of  the  mother.  The  term  abortion, 
or  miscarriage,  is  understood  in  medicine  to  express  the 
expulsion  of  the  fetus  before  the  sixth  month  of  gestation, 
or  before  it  is  considered  viable  ;  after  this  period,  it  is  said 
to  be  a  premature  labor.  In  law,  however,  no  such  distinc- 
tion is  made,  the  expulsion  of  the  contents  of  the  uterus  at 
any  period  being  considered  an  abortion. 

It  is  not  necessary  here  to  discuss  at  what  period  of  utero- 
gestation  does  the  fetus  become  endowed  with  life.  The 
fact  that  it  evinces  no  palpable  signs  of  life  before  quicken- 
ing is  no  proof  whatever  of  the  absence  of  life  ;  it  merely 
shows  that  the  life  is  extremely  feeble  in  that  early  stage  of 
its  being. 

Formerly,  the  laws  of  most  countries  recognized  a  dis- 
tinction between  an  abortion  produced  before  and  after 
quickening,  awarding  a  much  milder  punishment  to  the 
former  than  to  the  latter.  The  most  recent  laws  of  the 
United  States  and  Great  Britain  recognize  no  such  distinc- 
tion in  regard  to  the  criminality  of  the  act,  in  relation  to 
the  time  of  commission.  But  cases  of  feticide,  although 
extremely  common,  veiy  rarely  become  the  subject  of  a 
criminal  trial,  unless  they  have  resulted  in  the  death  of  the 
woman,  in  which  case  it  is  regarded  as  murder. 

Before  considering  the  medico-legal  bearings  of  the  sub- 
ject, it  will  be  proper  to  advert  to  the  fact  that  abortion  very 

220 


CRIMINAL    ABORTION.  221 

frequently  occurs  from  natural  causes.  With  some  women 
a  miscarriage  results  in  the  early  months  of  every  preg- 
nancy, and  this  in  spite  of  every  effort  to  prevent  it.  This 
tendency  to  abort  is  greatest  at  the  menstrual  periods. 
Among  the  causes  of  the  abortion  are  certain  constitutional 
diseases,  as  syphilis,  small-pox,  fevers,  albuminuria,  exces- 
sive passions,  poisons,  death  of  the  ovum,  or  disease  of  the 
placenta  and  membranes.  The  question  whether  a  natural 
tendency  to  abort  would  mitigate  the  criminality  of  the  act 
of  producing  it,  when  it  resulted  in  the  death  of  the  woman, 
would  doubtless  receive  a  negative  reply. 

The  two  leading  medico-legal  questions  in  every  case  of 
feticide  are  :  Has  the  fetus  in  utero  been  actually  destroyed, 
and  what  are  the  evidences  ?  Has  this  been  brought  about 
by  natural  (including  accidental)  causes,  or  by  artificial  (or 
criminal)  rfieans  ? 

I.  What  are  the  proofs  that  a  fetus  has  been  destroyed  ?  - 
These  are  derived  (i)  from  an  inspection  of  what  has  been 
expelled  from  the  uterus,  and  (2)  from  an  examination  of 
the  reputed  mother. 

I .  By  an  inspection  of  what  has  been  expelled  from  the 
uterus,  we  can  discriminate  between  a  true  fetus  and  other 
bodies,  such  as  hydatids,  moles,  polypi,  and  membranes. 
The  age  of  the  fetus  may  also  be  fixed  with  tolerable  accu- 
racy. As  regards  the  nature  of  the  other  substances,  which 
may  be  expelled  from  the  womb,  it  may  be  remarked  that 
the  true  hydatid  is  exceedingly  rare.  The  hydatidiform,  or 
vesicular  mole,  is  of  quite  frequent  occurrence  ;  it  arises 
from  a  diseased  condition  of  the  vilH  of  the  chorion  ;  these 
become  infiltrated  with  serum,  and  hang  in  masses,  like 
bunches  of  grapes.  These  growths  are  unquestionably  the 
result  of  impregnation. 


222  MEDICAL    JURISPRUDENCE. 

Moles  are  also  the  result  of  a  diseased  condition  of  the 
membranes  or  placenta.  The  fleshy  mole  is  composed  of 
layers  of  fibrous  matter  enclosing  a  central  cavity,  in  which 
sometimes  fragments  of  the  embryo  may  be  seen.  It  would 
seem  to  result  from  hemorrhage  into  the  chorion.  In  the 
fatty  mole  there  has  also  been  an  early  death  of  the  fetus, 
with  fatty  degeneration  of  the  placenta.  A  withered  fetus 
may  often  be  observed,  connected  with  the  diseased  pla- 
centa. Both  these  varieties  of  moles  are  positive  evidences 
of  pregnancy. 

Other  substances  besides  the  above  may  be  expelled 
from  the  uterus,  which  are  not  the  result  of  impregnation, 
such  as  false  membranes,  the  product  of  dysmenorrhea,  and 
also  polypi.  All  these,  of  course,  should  be  subjected  to  a 
microscopic  examination  before  an  opinion  is  ventured,  and 
lest  an  unwarranted  imputation  be  formed  against  the 
character  of  the  woman. 

A  fact  of  some  medico-legal  importance  in  connection 
with  this  subject  is  that  natural  abortion  usually  occurs 
about  the  third  or  fourth  month,  and  the  ovum  is  nearly 
always  expelled  entire  —  i.  e.,  the  membranes  not  ruptured. 
But  as  criminal  abortion  is  usually  produced  about  the  same 
time,  by  perforating  the  membranes,  of  course  the  fetus 
would,  in  that  case,  be  expelled  first,  and  the  placenta  and 
membranes  afterward.  This  latter  circumstance  might  aid 
materially  in  the  diagnosis  of  the  case. 

2.  The  signs  of  an  abortion  deduced  from  an  examina- 
tion of  the  reputed  mother.  These  signs  are  by  no  means 
satisfactory,  especially  if  the  abortion  has  occurred  in  the 
early  months  of  gestation.  The  discharges  of  blood  and  the 
relaxed  condition  of  the  vagina  might  easily  be  ascribed  to 
menstruation,  and  the  somewhat  open  state  of  the  os  uteri 


CRIMINAL   ABORTION.  223 

might  merely  indicate  some  disease  of  that  organ.  Hence 
a  woman  may  more  readily  conceal  her  condition  in  the 
early,  than  in  the  later  months  of  pregnancy  ;  but  in  pro- 
portion as  it  approaches  the  full  term,  the  signs  of  the 
abortion  become  more  definite,  resembling  those  of  delivery, 
and  which  will  be  discussed  hereafter. 

When,  however,  death  has  followed  within  three  or  four 
days  after  the  attempt  to  procure  the  abortion,  the  case  may 
usually  be  made  out  satisfactorily  ;  but  if  the  woman  sur- 
vives three  or  four  weeks,  it  will  be  almost  impossible  to 
determine  it  by  the  autopsy,  since  all  the  usual  signs  will 
have  disappeared  ;  and  this  is  especially  true  where  the 
abortion  has  occurred  in  the  early  stage  of  pregnancy. 

In  a  fatal  case  of  criminal  abortion,  the  first  duty  of  a 
physician  is  to  ascertain  how  far  this  is  to  be  ascribed  to 
the  means  employed.  For  this  purpose  the  vagina  and 
uterus  should  be  examined  for  marks  of  injury  by  the  use 
of  instruments.  Wounds  on  the  walls  of  the  vagina  would 
indicate  the  use  of  instruments,  most  probably  by  an  inex- 
perienced hand  ;  whilst  perforations  of  the  neck  of  the 
womb,  and  sometimes  of  its  fundus,  indicate  the  use  of 
pointed  instruments,  very  possibly  in  the  hands  of  a 
professed  abortionist. 

In  some  instances  a  blunt  instrument,  such  as  a  cathe- 
ter, is  employed  ;  and  in  a  case  that  some  time  since  came 
under  Dr.  Reese's  observation,  the  attempt  to  perforate  the 
membranes  seemed  to  have  failed,  while  the  instrument 
employed  passed  up  between  the  membranes  and  the  uterine 
walls,  and  tore  the  placenta,  producing  internal  hemor- 
rhage, and  ending  fatally.  In  cases  of  instrumental  violence 
there  will  frequently  be  discovered  marks  of  metritis  and 
peritonitis.     The  stomach  and  bowels  should  likewise  be 


224  MEDICAL   JURISPRUDENCE. 

carefully  inspected  for  signs  of  irritant  poisons  (abortives), 
such  as  redness  and  the  remains  of  the  various  reputed 
abortives,  as  powdered  cantharides,  savin,  ergot,  etc.;  also 
for  the  oils  of  savin,  tansy,  pennyroyal,  etc.;  the  latter  may 
sometimes.be  recognized  by  the  odor,  or  they  may  be  sepa- 
rated by  distillation  or  by  ether. 

In  all  fatal  cases  of  feticide  the  condition  of  the  uterus 
and  its  appendages  should  be  examined,  so  as  to  form,  at 
least,  an  approximate  estimate  of  the  period  of  the  preg- 
nancy. The  uterus  in  the  unimpregnated  (normal)  state 
measures  (according  to  Montgomery)  about  two  and  a  half 
inches  long,  one  and  three  quarter  inches  broad,  and  one 
inch  thick.  Its  size,  of  course,  gradually  increases  as  preg- 
nancy advances,  according  to  the  following  average :  very 
little  change  occurs  during  the  first  month.  During  the 
second  month  it  enlarges  considerably.  At  the  end  of  the 
third  month  its  length  is  five  inches,  of  which  one  inch  is 
for  the  cervix.  At  the  end  of  the  fourth  month  it  is  five 
inches  long  from  the  fundus  to  the  beginning  of  the  cervix. 
At  the  end  of  five  months,  its  length  is  six  inches.  At  six 
months,  the  length  is  seven  inches.  At  seven  months,  it  is 
eight  inches.  At  eight  months,  it  is  nine  to  nine  and  a  half 
inches.  At  nine  months,  it  is  ten  and  a  half  to  twelve 
inches  in  total  length. 

If  death  should  occur  from  hemorrhage,  at  full  term,  no 
contraction  of  the  womb  will  have  taken  place ;  but  if  the 
woman  survive  for  a  few  days,  there  will  always  be  more  or 
less  contraction  of  that  organ.  In  two  days  after  delivery 
(at  full  term),  the  womb  will  have  contracted  down  to  seven 
inches  in  length  and  four  in  width ;  after  one  week  it  will 
be  about  five  or  six  inches  long  and  two  wide ;  after  two 
weeks,  the  length  is  four  or  five  inches,  and  the  width  one 


CRIMINAL   ABORTION.  22$ 

and  a  half  inches.     At  the  end  of  the  second  month,  it  will 
have  attained  its  normal  size. 

Its  shape  also  changes  as  well  as  its  size.  In  the  unim- 
pregnated  state  it  is  flat,  pyriform,  and  somewhat  triangular. 
After  impregnation  it  assumes  somewhat  of  a  globular 
shape  ;  but  no  change  of  consequence  occurs  in  the  cervix 
until  about  the  fifth  month,  after  which  it  progressively 
shortens,  losing  one  fourth  its  length  in  the  sixth  month, 
another  fourth  in  the  seventh  month,  still  another  fourth 
in  the  eighth  month,  and  at  the  close  of  the  ninth  month, 
or  full  .term,  becoming  entirely  obliterated,  so  that  at  this 
period  the  shape  of  the  uterus  is  ovoid. 

The  thickness  of  its  walls  at  full  term  is  about  that  of  the 
unimpregnated  condition  —  one  third  to  two  thirds  of  an 
inch  ;  but  in  a  few  hours  after  delivery,  under  contraction, 
its  thickness  increases,  often  to  two  inches. 

The  uterine  vessels  undergo  considerable  enlargement  in 
pregnancy  —  especially  the  veins,  which  attain  such  dimen- 
sions as  to  be  denominated  sinuses,  at  the  position  where 
the  placenta  is  attached.  The  ligaments  of  the  uterus  like- 
wise share  in  the  general  change.  The  broad  ligaments 
become  gradually  effaced,  in  consequence  of  being  absorbed 
(so  to  speak)  in  the  increased  development  of  the  uterus. 
The  round  ligaments  increase  in  thickness.  Both  become 
extremely  vascular. 

The  Fallopian  tubes  increase  in  size,  become  less  convo- 
luted, and  are  much  more  vascular.  Usually  that  one 
through  which  the  ovum  has  passed  is  somewhat  the 
larger.  The  ovaries  also  share  in  the  general  increased 
vascularity.  That  one  from  which  the  ovum  escaped  dis- 
plays a  peculiar  fullness  or  prominence  at  one  portion  of 
the  organ.      If  this  be  cut  open,  a  yellowish-looking  body 

19 


226  MEDICAL   JURISPRUDENCE. 

will  be  observed,  named  corpus   luteum,  which  has  already 
been  described. 

It  should  not  be  forgotten  that  all  the  above  signs  of 
abortion  may  occur  after  the  expulsion  of  hydatids  and 
moles  ;  also,  that  a  corpus  luteum  may  be  found  in  the 
virgin  state. 

It  will  be  proper  here  to  describe  the  gradual  development 
of  the  fetus,  together  with  its  appearance  at  the  different 
stages  of  its  growth,  so  as  to  furnish  the  data  for  establish- 
ing its  probable  uterine  age.  At  the  earliest  period  when 
the  human  embryo  can  be  discerned  (from  fourteen  to 
eighteen  days),  it  presents  the  appearance  of  a  flocculent 
mass,  of  a  semi-transparent,  gelatinous  consistence,  about 
two  and  a  half  lines  in  length. 

In  the  third  or  fourth  week,  the  length  of  the  embryo  is 
from  four  to  six  lines  ;  the  weight  twenty  grains.  Its  form 
is  curved,  and  already  the  rudiments  of  the  several  organs 
are  visible  in  the  shape  of  dots  and  protuberances.  At  the 
end  of  the  eighth  week,  the  length  is  fifteen  to  eighteen 
lines  ;  the  weight,  two  to  five  drachms.  The  head  forms 
more  than  two  thirds  of  the  body ;  the  features  are  more 
distinguishable,  and  the  sex  may  sometimes  be  made  out. 
At  the  end  of  the  twelfth  week  (three  months),  the  length  is 
two  and  a  half  to  three  inches  ;  weight,  one  to  two  ounces. 
The  whole  ovum  is  now  about  the  size  of  a  goose  egg.  The 
fingers  are  separated,  but  the  toes  not ;  the  genital  organs 
very  prominent.  At  the  end  of  four  months,  the  length  is 
five  to  seven  inches ;  weight,  six  to  seven  ounces.  The  skin 
rosy,  very  delicate,  and  covered  with  a  fine  down  ;  hair  on 
the  head  short  and  silvery.  The  disproportionate  quantity 
of  the  amniotic  liquor  disappears,  and  the  fetus  nearly  fills 


CRIMINAL    ABORTION.  22/ 

up  the  cavity  of  the  uterus.  At  the  end  of  five  months, 
the  length  is  from  eight  to  ten  inches  ;  weight,  eight  to  ten 
ounces  ;  nails  distinct ;  the  head,  liver,  heart,  and  kidneys 
disproportionately  large.  If  abortion  occurs  now,  the  mem- 
branes are  usually  first  ruptured  and  the  fetus  escapes. 

At  the  end  of  the  sixth  month  the  length  is  about  twelve 
inches  ;  weight,  about  one  pound  or  over.  The  color  of  the 
body  is  of  a  cinnabar-red ;  down  and  sebaceous  matter  cover 
the  skin  ;  umbilicus  a  little  above  the  pubis  ;  fat  in  small 
quantities  under  the  skin  ;  head  very  soft ;  fontanelles  widely 
separated ;  palms  of  hands  and  soles  of  feet  purpHsh  ; 
scrotum  empty ;  labia  project,  but  do  not  conceal  the  clito- 
ris ;  the  membrana  pupillaris  still  distinct ;  nails  distinct ; 
meconium  in  small  quantity  in  the  large  intestines  ;  bladder 
hard  and  pyriform,  with  a  very  small  cavity.  At  the  end  of 
the  seventh  month,  the  length  is  fourteen  to  fifteen  inches  ; 
weight,  two  to  four  pounds.  The  skin  is  of  a  dirty-red 
color ;  hair  on  the  head  about  half  an  inch  long ;  membrana 
pupillaris  disappearing  ;  eyelids  no  longer  adherent ;  nails 
more  firm  ;  convolutions  begin  to  form  on  the  brain  ;  meco- 
nium is  more  abundant ;  the  ears  lie  close  to  the  side  of  the 
head.  If  the  child  should  now  be  born,  the  arms  and  legs 
will  be  bent  in  the  position  they  maintained  in  the  womb. 

At  the  end  of  the  eighth  month,  the  length  is  fifteen  to 
sixteen  inches  ;  weight,  three  to  four  pounds.  The  skin  is 
thicker  and  more  natural,  and  is  covered  with  a  fine,  soft 
hair ;  hair  on  head  is  darker ;  nails  firmer ;  breasts  often 
projecting  ;  the  testes  still  at  the  rings,  but  often  one  (the 
left)  is  found  in  the  scrotum  ;  lungs  are  reddish ;  liver  still 
very  large  ;  membrana  pupillaris  absent.  At  the  end 
of  the  ninth  month,  the  length  is  eighteen  to  twenty  inches  ; 
weight  (average)  seven  pounds  ;  ossification  more  complete  ; 


228  MEDICAL  JURISPRUDENCE. 

bones  of  cranium  touch  each  other ;  fontanelles  smaller ; 
hair  on  head  longer  and  darker ;  nails  more  solid,  and  pro- 
longed to  the  ends  of  the  fingers ;  convolutions  of  brain 
more  numerous  ;  lungs  redder  and  more  voluminous  ;  me- 
conium nearly  fills  the  whole  intestine  ;  bladder  contains 
urine ;  both  testes  descended,  and  vulva  closed. 

In  the  development  of  the  fetal  brain,  its  form  and  dis- 
position, as  also  that  of  the  spinal  cord,  can  be  recognized 
as  early  as  the  eighth  week.  In  the  third  month,  the  tuber- 
cula  quadrigemina,  optic  thalami,  and  corpora  striata  are 
seen  ;  the  medulla  oblongata  can  be  distinguished  about 
the  sixth  or  seventh  month.  The  gray  portion  is  not 
formed  until  nearly  the  end  of  the  ninth  month.  The  weight 
of  the  fetal  brain,  as  stated  by  Wenzels,  is  —  at  five  months, 
720  grains  ;  at  eight  months,  4,960  grains  ;  at  nine  months, 
6, 1 50  grains. 

The  point  of  insertion  of  the  umbilical  cord  will  aid  in 
determining  the  age  of  a  fetus,  when  about  its  full  term. 
From  numerous  observations,  the  conclusion  arrived  at  is, 
that  at  full  term  the  cord  is  inserted  a  few  lines  below  the 
middle  of  the  body ;  earlier  than  this,  the  point  of  insertion 
is  at  the  center.  Moreau's  observations,  at  the  Mater- 
nite  of  Paris,  show,  that  out  of  five  hundred  cases  at  full 
term,  in  only  four  was  the  umbilicus  exactly  in  the  center 
of  the  body ;  in  all  the  rest,  it  was  from  eight  to  ten  lines 
below  it. 

Beclard  and  others  have  pointed  out  a  very  certain  test 
of  the  age  of  the  fetus  about  the  full  term,  viz.,  the  osseous 
deposit  in  the  inferior  epiphysis  of  the  femur.  If  there  is  no 
visible  trace  of  this,  the  fetus  cannot  be  over  eight  months  ; 
if  it  has  the  size  of  a  hemp  seed  (half  a  line),  it  is  in  the 
ninth  month  ;    and  if  from  two  to  three  lines  in  diameter,  it 


CRIMINAL   ABORTION;  229 

has  arrived  at  full  term  ;    if  more  than  thfee  liri6S,  the  child 
has  probably  lived  after  its  birth. 

The  weight  of  children  born  at  the  full  term  varies  very 
considerably.  As  already  stated,  the  average  weight  may 
be  taken  at  about  seven  pounds,  —  rather  less  in  females  ; 
but,  in  many  instances,  the  weight  far  exceeds  this.  Dr. 
Owens  mentions  one  that  weighed  seventeen  and  three 
quarter  pounds,  and  that  measured  twenty-four  inches  in 
length.  Dr.  Meadows  gives  one  that  weighed  eighteen 
pounds  and  two  ounces,  and  measured  thirty-two  inches. 
Dr.  Donellan,  of  Louisiana,  mentions  a  case  of  triplets,  of 
which  one  weighed  nine  and  a  half  pounds,  one  seven  and  a 
half  pounds,  and  one  seven  pounds,  the  united  weight  being 
twenty-four  pounds.  On  the  other  hand,  children  at  full 
term  often  fall  below  the  average,  weighing  only  from  four 
to  six  pounds. 

II.  The  second  medico-legal  question  is,  Was  the  abortion 
produced  by  natural,  or  by  artificial  (criminal)  means  ?  The 
examination  of  the  reputed  mother,  especially  if  death  has 
resulted,  would  generally  settle  this  question  satisfactorily 
by  the  presence  or  absence  of  the  results  of  instrumental  or 
other  interference.  It  will  be  proper  here  to  point  out  the 
various  means  that  are  generally  J  resorted  to  in  order  to 
effect  the  purpose.  These  criminal  means  may  be  consid- 
ered under  the  heads  of  general  and  special.  And  here 
it  may  be  premised  that,  as  an  almost  universal  rule,  where 
there  is  no  constitutional  predisposition  on  the  part  of  the 
woman  to  abort,  this  process  can  very  rarely  be  effected 
except  by  instrumental  interference.  Hence,  the  violent 
measures  which  are  sometimes  resorted  to  to  accomplish  it. 
Many  cases  are  reported  where  severe  bodily  injuries  have 


230  MEDICAL   JURISPRUDENCE, 

been  inflicted  with  a  view  to  bring  on  an  abortion,  but  with- 
out the  desired  result.  The  most  violent  exercise,  and  the 
most  brutal  violence  have  been  submitted  to  without  success. 

1.  The  general  means  include  repeated  blood-letting, 
emetics,  and  drastic  purgatives.  Blood-letting  often  acts 
as  the  most  effectual  means  of  preventing  abortion  in 
plethoric  women  ;  nevertheless,  if  it  could  be  shown  in  a 
case  of  abortion  that  the  female  had  previously  resorted  to 
frequent  bleedings,  this  fact  might  be  received  as  presump- 
tive evidence  against  her.  The  same  is  true  of  the  employ- 
ment of  leeches. 

The  above  remarks  are  also  applicable  to  the  use  of 
emetics.  Although  violent  vomiting  might  bring  on  prema- 
ture labor  in  the  last  stages  of  pregnancy  in  feeble  women, 
it  can  have  no  effect  in  the  earlier  months.  The  well-known 
nausea  and  vomiting  (the  latter  sometimes  quite  violent)  of 
pregnancy  do  not  produce  miscarriage. 

The  drastic  cathartics  are  often  resorted  to  for  the  same 
purpose ;  they  may  possibly  effect  it  in  weak  women; 
especially  if  predisposed  to  miscarriage,  but  as  a  general 
rule  they  are  powerless. 

2.  The  special  means  employed  comprise  the  use  of  certain 
drugs  which  are  supposed  to  possess  the  power  to  excite 
uterine  contraction,  and  are  therefore  named  emmenagogues 
and  abortives ;  and  also  the  use  of  instrumental  measures  for 
the  purpose  of  puncturing  the  membranes,  and  so  inducing 
uterine  contraction.  The  number  of  the  popular  abortives 
is  very  considerable  ;    only  a  few  need  be  noticed  here. 

Ergot,  or  Spurred  Rye,  undoubtedly  possesses  ecbolic 
properties  ;  that  is,  it  is  capable  of  causing  contractions  of 
the  uterus  during  labor,  but  it  is  not  certain  that  it  can 
affect  this  organ  in  the  earlier  stages  of  pregnancy.      It  is. 


CRIMINAL   ABORTION.  23  I 

however,  certain  that  it  very  often  fails  to  bring  on  miscar- 
riage, although  large  and  repeated  doses  have  been  taken. 

Cotton  root  {Gossypiiun  lierbaccuui)  has  a  wide  reputation 
as  an  abortive.  It  is  even  said  to  be  more  certain  and 
powerful  than  ergot. 

Savin  (tops  oi  Juniperiis  sabind)  is  highly  esteemed  as  an 
ecbolic.  Its  virtues  depend  on  a  volatile  oil  (oil  of  savin), 
which  is  also  much  employed  as  a  popular  abortive.  Savin 
is  a  powerful  irritant  to  the  stomach  and  bowels.  The  oil 
has  frequently  caused  death  through  peritonitis  and  gastritisl 
without  discharging  the  fetus.  It  is  an  exceedingly  dan- 
gerous remedy.  Tansy,  pennyroyal  and  rue  all  act  in  a 
similar  manner ;  they  each  contain  a  powerful  volatile  oil, 
which  is  considerably  used  as  an  abortive,  but  in  the 
majority  of  cases  without  the  result  intended.  They  fre- 
quently produce  the  death  of  the  woman  through  their 
violent  irritant  action.  Various  other  substances  are  em- 
ployed as  abortives,  such  as  cantharides,  copper  sulphate, 
cimicifuga,  and  potassium  iodid,  etc.  Of  one  and  all  of  the 
above  reputed  abortives  it  may  be  affirmed,  without  contra- 
diction, that  they  are  uncertain  in  their  operation  on  the 
uterus,  that  they  always  endanger  the  mother's  life,  and  that 
they  not  infrequently  destroy  the  mother,  without  effecting 
the  discharge  of  the  fetus. 

The  special  means  also  comprise  blows  and  violent  pres- 
sure made  upon  the  abdomen,  loins,  and  back  of  the  woman. 
Occasionally,  but  by  no  means  always,  such  procedures  may 
result  in  the  expulsion  of  the  fetus,  but  they  necessarily 
entail  great  risk  of  Hfe  to  both  mother  and  child.  The  use 
of  pointed  instruments  introduced  into  the  uterus  so  as  to 
rupture  the  membranes  is  the  only  certain  method  of  pro- 
ducing uterine  contraction   and  insuring    the  expulsion  of 


232  MEDICAL  JURISPRUDENCE. 

its  contents.  This  operation  in  the  hands  of  empirics,  or  of 
the  female  herself,  is  often  followed  by  very  serious  and 
fatal  consequences,  from  wounding  and  even  perforating  the 
womb.  Other  methods  are  sometimes  successfully  em- 
ployed, as  the  injection  of  warm  water  between  the  uterus 
and  ovum,  and  the  dilatation  of  the  os  uteri  by  means  of 
sponge  and  other  tents,  or  by  the  use  of  Barnes'  dilator. 
A  case  is  mentioned  by  Dr.  Channing,  in  which  a  bent  wire 
was  introduced  into  the  uterus,  where  it  became  entangled 
in  the  tissue  and  had  to  be  cut  off;  the  piece  remained 
within  for  six  years,  and,  singular  to  remark,  the  case  was 
one  of  merely  suspected  pregnancy.  In  another  case, 
strong  sulphuric  acid  was  injected  into  the  vagina  for  the 
purpose  of  bringing  on  an  abortion.  The  result  was  violent 
inflammation,  causing  adhesion  of  the  walls  of  the  vagina, 
and  also  of  the  bladder.  The  Caesarean  section  was  finally 
performed,  which  terminated  fatally. 

Druggists  are  often  asked  for  substances  to  produce 
abortion,  and  in  order  not  to  offend  by  refusing  to  sell, 
yet  not  involve  themselves  in  a  criminal  act,  dispense 
harmless  powder,  such  as  milk-sugar  or  starch  mixed  with 
a  small  amount  of  quinin  to  give  a  marked  taste,  and  thus 
lead  the  person  to  believe  that  an  active  drug  is  being 
used. 

Before  leaving  this  subject,  it  is  proper  to  state  that  the 
operation  for  abortion  may  sometimes  become  necessary 
in  regular  medical  practice.  The  cases  demanding  it  are 
deformity  of  the  pelvis  to  such  an  extent  as  to  preclude  the 
possibility  of  delivery  of  a  living  child  at  full  term  ;  and 
possibly  when  the  vomiting  during  pregnancy  is  of  such  a 
violent  and  continued  character  as  actually  to  endanger  the 
mother's  life.      In  every  such  case,  however,  the  practitioner 


CRIMINAL  ABORTION.  233 

should  secure  a  consultation  before  venturing  to  perform 
the  operation. 

Abortion  may  sometimes  be  feigned  for  sinister  purposes, 
such  as  to  secure  compensation  for  an  alleged  seduction  and 
consequent  pregnancy,  or  to  excite  sympathy  and  aid.  In 
such  cases,  a  thorough  examination  of  the  woman  and  the 
alleged  fetus  will  serve  to  clear  the  matter  up. 

Legally  considered,  the  criminality  of  abortion  is  not 
affected  by  the  fact  that  the  woman  was  not  really  pregnant, 
nor  by  the  birth  of  monstrosities  or  of  moles,  nor  by  the 
fact  of  an  extra-uterine  pregnancy. 


CHAPTER   X. 

INFANTICIDE. 

By  Infanticide  is  understood  the  criminal  destruction  of 
the  new-born  child.  In  a  legal  sense,  it  is  immaterial 
whether  the  child  is  killed  immediately  after  its  birth,  or  a 
few  days  subsequently. 

The  crime  of  Infanticide  has  been  prevalent  throughout 
the  world,  from  the  remotest  period  of  history.  Before  the 
establishment  of  Christianity  it  was  allowed  among  the 
most  enlightened  and  cultivated  nations  of  the  earth,  and 
even  at  the  present  day  its  practice  is  frequent  in  the  most 
civilized  countries,  although  placed  under  the  ban  of  the 
law,  and  involving  mostly  the  destruction  of  illegitimate 
children.  Child-murder  is  treated  by  the  law  like  any 
other  form  of  homicide,  and  tried  by  the  usual  rules  of 
evidence  in  such  cases.  There  is  this  important  point  in 
the  nature  of  the  medical  evidence  required,  namely,  that  it 
must  prove  satisfactorily  that  the  child  was  born  alive ;  in 
other  words  the  burden  of  proof  that  a  living  child  was 
destroyed  is  thrown  upon  the  prosecution.  The  law  hu- 
manely assumes  that  every  child  is  born  into  the  world 
dead,  until  the  contrary  is  shown,  because  so  many  children 
do  thus  actually  come  into  the  world,  and  many  others  die 
very  soon  after,  from  various  causes ;  and  in  these  latter, 
the  signs  of  their  having  lived  are  frequently  indistinct. 
As  the  charge  of  infanticide  can  never  be  sustained  unless 
there  is  distinct  proof  that  the  child  was  legally  alive  at  its 
birth,  great  difficulty  is  usually  experienced  in  obtaining 
sufficient  evidence  to    convict   a    woman   accused  of  this 

234 


INFANTICIDE.  235 

crime.  As  a  general  rule,  she  has  been  delivered  in  secret, 
with  no  witness  of  the  birth  ;  and  the  body  of  the  child  is 
frequently  concealed  or  destroyed.  There  is,  besides,  a 
general  reluctance  on  the  part  of  a  jury  to  convict  a  woman 
of  willful  murder  for  this  crime,  horrible  as  it  is,  on  account 
of  a  feeling  of  sympathy  for  the  prisoner  arising  from  the 
probability  of  her  seduction  and  desertion. 

The  term  "born  alive,"  in  the  legal  sense,  implies  the 
complete  expulsion  of  a  living  child  from  the  mother.  A 
child  is  not  "  born  "  legally,  if  any  portion  of  its  body — a 
leg,  for  instance  —  is  retained  within  the  vulva.  Hence, 
through  a  fiction  of  the  law,  the  destruction  of  a  living 
child,  if  only  partially  born,  is  not  regarded  as  murder  !  It 
is  not,  however,  necessary  that  the  umbiHcal  cord  should 
be  cut,  in  order  to  come  within  the  meaning  of  the  statute. 

In  the  majority  of  cases  of  infanticide,  the  child  has  ar- 
rived at  the  full  term  of  gestation  ;  but,  as  children  are  often 
born  at  an  earlier  period,  —  either  naturally,  or  by  artificial 
means,  — the  examiner  should  be  prepared,  from  the  inspec- 
tion of  the  body,  to  give  an  opinion  as  to  the  probable  age 
that  the  child  had  attained  in  the  uterus.  For  this  purpose, 
he  should  be  acquainted  with  the  general  appearance,  size, 
and  development  of  the  fetus  at  the  different  periods  of  its 
uterine  life. 

In  a  case  of  infanticide,  the  medico-legal  questions  in- 
volved pertain,  first,  to  the  infant,  and,  secondly,  to  the 
reputed  mother. 

I.  Questions  relating  to  the  infant  :  (i)  Was  it  born  alive  ? 
(2)  What  was  the  cause  of  its  death  ?  (3)  Its  age  ?  (4) 
The  interval  since  its  deatli  ? 

I.  Was  it  born  alive?  In  the  absence  of  all  positive 
evidence  from  witnesses,  the  inference  must  be  derived  from 


236  MEDICAL   JURISPRUDENCE. 

the  external  appearance,  and  from  the  internal  examination 
of  the  child's  body.  The  general  appearance  of  the  body  of 
an  infant  that  was  born  alive,  at  full  term,  and  had  breathed, 
may  be  described  as  follows  :  The  remains  of  the  sebaceous 
matter  (ve^^nix  caseosa)  will  usually  be  found  under  the  arm- 
pits and  behind  the  ears  ;  the  hair  will  be  dry  and  clean  ; 
the  ears  do  not  lie  so  close  to  the  side  of  the  head  as  in 
dead-born  children  ;  the  eyes  remain  half  open,  in  spite  of 
all  efforts  to  close  them  ;  the  capiit  succedaneum,  or  swell- 
ing on  the  back  of  the  head,  is  much  more  distinct  than  in 
the  still-born  child  ;  the  former  contains  a  glutinous,  bloody 
serum,  while  in  the  latter  there  is  only  a  small  quantity  of 
colorless  liquid.  The  thorax  is  more  arched,  and  the  dia- 
phragm more  depressed,  than  in  the  case  of  the  still-born. 
According  to  Casper,  the  highest  level  of  the  diaphragm 
in  the  still-born  child  is  between  the  fourth  and  fifth  ribs, 
while  it  descends  to  between  the  sixth  and  seventh  in  the 
living.  The  lungs  will  also  present  unmistakable  evidences, 
which  will  be  described  later.  The  remnant  of  the  umbilical 
cord  attached  to  the  body  will  exhibit  evidence  of  com- 
mencing desiccation,  if  the  child  has  lived  for  a  few  hours. 

A  dead-born  child,  having  perished  immediately  before 
its  birth,  will  usually  be  found  more  or  less  covered  with 
the  vernix  caseosa ;  its  hair  closely  agglutinuted  ;  ears  lie 
close  to  the  side  of  the  head  ;  eyes  closed,  and  eyeHds, 
when  raised,  do  not  remain  open  ;  mouth  closed,  and  a 
drop  of  watery  blood  is  often  seen  trickhng  from  the  nostril. 
The  thorax  appears  flat  and  unexpanded ;  the  trachea  is 
flattened,  and  often  contains  a  viscid,  mucous  secretion. 
The  lungs  lie  in  the  posterior  part  of  the  thorax  ;  they  are 
of  a  brownish-red  color,  have  a  granular  structure,  and  do 
not  crepitate  upon  pressure  ;  their  length  is  greater  than 


INFANTICIDE.  237 

their  breadth,  and  their  edges  are  rounded.  The  remnant 
of  the  umbilical  cord  has  a  fresher  look  than  when  the  child 
has  lived  a  few  hours. 

If  the  death  of  the  fetus  has  occurred  some  time  before 
its  birth,  there  will  be  the  following  signs  of  intra-uterine 
putrefaction  :  The  body  is  extremely  flaccid  and  flattened, 
as  if  it  had  been  macerated  in  water ;  the  skin  is  spotted, 
and  the  cuticle  detached  in  many  places,  especially  on  the 
abdomen  ;  the  head  lies  perfectly  flat  in  any  position  ;  the 
bones  of  the  cranium  move  easily  on  one  another ;  the  face 
is  flattened  and  the  features  distorted.  The  cellular  tissue 
and  cavities  are  infiltrated  with  a  bloody  serum  ;  the  viscera 
are  easily  loosened  from  one  another ;  gas  is  developed  in 
the  lungs  and  liver.  The  color  of  the  lungs  is  dark  brown. 
There  is  an  absence  of  the  usual  odor,  and  also  of  the  green 
color  of  ordinary  putrefaction. 

It  is  important  to  have  clear  and  definite  ideas  concern- 
ing the  proofs  of  a  live  birth,  in  cases  of  infanticide.  It  is 
well  known  that  many  children  come  into  the  world  still- 
born —  that  is,  without  giving  any  sign  of  life  by  respiration 
or  otherwise — and  yet,  by  proper  attention,  they  subse- 
quently revive  and  continue  to  live.  From  this  it  is  to  be 
inferred  that  respiration  is  not  the  only  evidence  of  a  live 
birth.  Nevertheless,  in  the  cases  of  infanticide  that  come 
under  judicial  investigation,  in  which  the  proofs  of  a  living 
birth  are  to  be  discovered  solely  by  an  inspection  of  the 
dead  body  of  the  child,  the  fact  of  respiration  is  the  main 
point  to  be  determined  by  the  examiner.  If  this  fact  can 
be  satisfactorily  proved,  there  can  be  no  doubt  that  the 
child  had  lived  ;  but  it  does  not  necessarily  prove  that  it 
was  born  alive,  since  it  might  have  perished  (naturally  or 
otherwise)  before  it  was  actually  born,  in  the  legal  sense. 


238  MEDICAL   JURISPRUDENCE. 

Again,  a  child  may  live  for  several  hours  after  its  birth, 
breathing  very  feebly  ;  and  after  its  death  the  air  cells  of 
the  lungs  may  present  no  evidence  of  distention  ;  so  that, 
judged  by  this  single  sign  presented  after  death,  the  child 
would  be  said  to  have  been  born  dead. 

As  to  the  question  whether  any  evidence  of  life  before 
respiration  can  be  discovered  in  the  dead  body  in  a  case  of 
infanticide,  the  answer  must  be  that,  at  present,  there  are  no 
satisfactory  medical  data  to  enable  one  to  express  a  positive 
opinion  in  such  cases  —  certainly  not  from  a  mere  inspection 
of  the  lungs.  Should  there,  however,  be  other  evidence, 
such  as  marks  of  great  violence  upon  the  body,  or  proofs, 
through  witnesses,  that  respiration  had  been  designedly  pre- 
vented, either  by  the  woman  herself  or  by  an  accomplice, 
such  circumstances  would  certainly  afford  very  strong  pre- 
sumption of  murder.  Dr.  Causse,  quoted  by  Taylor,  con- 
tends that  a  true  ecchymosis  found  on  the  body  of  a  new- 
born child  is  proof  that  the  blood  was  circulating  at  the 
time,  and  that  it  had  been  extravasated,  which  could  only 
occur  in  a  living  body ;  and  that  this  proof  would  be 
strengthened  if  the  blood  was  found  coagulated,  and  the 
surrounding  tissues  deeply  infiltrated.  Devergie  held  a 
similar  opinion  in  relation  to  the  significance  of  ecchymoses 
and  infiltration  of  blood.  Still,  while  fully  admitting  the 
force  of  these  proofs  of  vitality  as  good  medical  evidence, 
they  are  scarcely  to  be  received  as  sufficient  of  themselves 
to  establish  the  charge,  since  they  are  open  to  the  objection 
that  the  injuries  might  have  been  inflicted  during  birth,  or 
accidentally  after  birth. 

Proofs  that  the  Child  lias  Breathed.  —  These  proofs  are 
derived  (i)  from  the  organs  of  respiration;  (2)  from  the 
organs  of  circulation  ;  (3)  from  the  abdominal  organs. 


INFANTICIDE.  239 

I .  Proofs  afforded  by  the  respiratory  organs. 

{a)  The  thorax  is  higher  or  more  vaulted  in  appearance 
than  when  the  child  has  not  breathed  ;  its  capacity  is 
increased  ;  but  the  attempt  to  indicate  these  changes  by 
actual  measurements  and  comparisons  cannot  be  depended 
upon,  on  account  of  the  natural  difference  in  the  size  of  the 
thorax  in  different  children  at  birth. 

{b)  The  diaphragm  is  considerably  more  depressed  after 
respiration  has  been  established  than  before ;  according  to 
Casper  (as  already  mentioned),  in  children  born  dead  its 
highest  point  reaches  between  the  fourth  and  fifth  ribs, 
whereas  in  those  born  alive  and  fully  respiring  it  descends 
to  between  the  sixth  and  seventh  ribs  ;  the  position  of  the 
diaphragm  may  also  be  affected  by  the  gases  produced 
during  putrefaction. 

(<r)  The  larynx,  before  breathing,  is  narrower,  contains 
more  or  less  mucus,  and  is  closely  approximated  to  the 
epiglottis  ;  after  respiration  it  is  wider,  and  is  not  closed  by 
the  epiglottis. 

{d')  The  Situation  and  Volume  of  the  Lungs.  —  Before 
breathing,  these  organs  are  placed  far  back  in  the  thorax, 
so  as  almost  to  escape  notice.  After  complete  respiration 
they  project  forward  so  as  completely  to  fill  the  cavity 
of  the  chest,  and  cover,  and  to  a  great  extent  conceal, 
the  heart  and  pericardium.  If  respiration  has  been  im- 
perfect, the  volume  of  the  lungs  is  proportionately  less 
developed. 

{e)  The  Consistence  of  the  Lungs.  —  Before  respiration 
they  have  a  firm  and  compact  feel,  and  they  are  of  the  con- 
sistency of  liver ;  after  full  breathing  they  are  spongy  and 
crepitant  to  the  touch.  When  cut,  there  is  an  escape  of 
blood-froth  ;    and  when  pressed  between  the  fingers  under 


240  MEDICAL   JURISPRUDENCE, 

water,  air-bubbles  will  rise  to  the  surface.  A  thin  section, 
when  examined  by  the  microscope,  will  show  distinct 
air  cells.  It  must,  however,  be  remembered  that  the 
lungs  of  infants  that  have  lived  a  considerable  time  after 
birth,  but  that  have  breathed  very  imperfectly,  will  some- 
times not  crepitate  under  the  finger,  nor  will  they  float 
on  water. 

(/)  Their  Color.  —  Before  respiration,  this  is  bluish-red  or 
violet,  resembling  that  of  the  spleen.  A  short  exposure  to 
the  air  will  render  the  color  brighter.  After  full  respiration 
their  color  changes  to  a  pale  red,  becoming  bright  scarlet 
after  free  exposure  to  the  air,  or  else  irregular  bright  spots 
appear  upon  a  bluish-red  ground,  giving  them  a  marbled 
appearance,  a  peculiarity  which  cannot  be  given  to  fetal 
lungs  by  artificial  inflation.  "  This  insular  marbling  of  the 
lungs  is  characteristic  of  lungs  that  have  breathed,  and  is 
due  to  the  presence  of  blood  in  the  vessels  surrounding  the 
inflated  lung  tissue"  (Husband).  In  imperfect  respiration, 
and  as  a  result  of  disease,  the  color  of  the  lungs  may  be 
much  modified. 

(g-)  Their  Absolute  Weight,  or  the  Static  Test.  — The 
weight  of  the  lungs  before  respiration  is  less  than  after  that 
process  has  been  established,  owing  to  the  presence  of  blood 
circulating  in  them.  The  average  weight  before  respiration, 
derived  from  nine  cases,  according  to  Taylor,  was  649 
grains.  Dr.  Traill  gives  it  as  varying  from  430  to  600 
grains.  The  average  weight  after  respiration,  in  three  cases, 
was  927  grains.  From  these  data  attempts  have  been  made 
to  institute  comparisons  in  unknown  cases ;  but  so  much 
depends  upon  the  maturity  or  immaturity  of  the  child  and 
the  degree  of  respiration,  that  the  test  is  unworthy  of  confi- 
dence.     Great  weight  of  the  lungs  cannot,  of  itself,  furnish 


INFANTICIDE.  24I 

proof  of  respiration,  unless  accompanied  by  increase  of  vol- 
ume from  the  presence  of  air,  and  by  crepitation  and  the 
distention  of  the  air  cells  ;  it  may  really  be  due  to  disease. 
Dr.  Taylor  relates  a  case  where  the  lungs  weighed  upward 
of  1,200  grains  ;  they  contained  no  air,  and  when  cut  into 
thirty  pieces  not  one  floated  on  water. 

Specific  Gravity  of  the  Lnngs. —  This  is  greater  beibre  than 
after  respiration  ;  because  the  air  received  throughout  the 
air  cells  in  breathing  more  than  counterbalances  the  addi- 
tional weight  derived  from  the  blood  circulating  through 
them.  Dr.  Taylor  found,  as  the  result  of  several  experi- 
ments, that  the  specific  gravity  of  the  lungs  in  the  fetal 
state  varied  from  1.04  to  1.05  ;  after  respiration  it  was  0.94 
(one  experiment).  It  will,  of  course,  be  understood  that  the 
specific  gravity  of  the  substance  of  the  lungs  remains 
unchanged  ;  it  is  only  rendered  apparently  lighter  by  the 
introduction  of  air  into  the  cells.  The  introduction  of  a 
very  small  quantity  of  air  is  sufficient  to  render  the  fetal 
lungs  buoyant  in  water ;  and  it  matters  not  whether 
this  air  is  derived  from  respiration,  artificial  inflation,  or 
putrefaction.  It  is  on  this  property  of  the  lungs  that 
the  application  of  what  is  termed  the  hydrostatic  test  is 
founded. 

The  Hydrostatic  Test  —  Dociniasia  Pulniomtm. —  The  prin- 
ciples involved  in  this  test  have  just  been  noticed  —  the  fact 
that  the  lungs  in  their  fetal  or  unaerated  condition  sink 
when  put  into  water,  while  the  lungs  of  a  child  that  has 
breathed,  or  where  they  have  been  otherwise  inflated,  float 
in  water. 

The  mode  of  applying  this  test  is  very  simple.  Having 
carefully  removed  the  lungs  from  the  chest  (usually  along 
with  the  heart  and  thymus  gland),  these  should  be  put  into 


242  MEDICAL   JURISPRUDENCE. 

a  sufficiently  capacious  vessel  containing  distilled,  or  river 
water,  at  6o°  F.  If  they  are  very  buoyant,  much  of  them 
floating  on  the  surface  of  the  water,  this  indicates  veiy 
complete  aeration  of  the  lungs,  and  may  be  regarded  as  a 
strong  proof  of  respiration  at  birth.  If  they  are  less  buoy- 
ant, floating  largely  under  the  surface,  the  indication  is  that 
the  aeration  was  not  complete.  Each  lung  should  now  be 
tried  separately,  to  determine  if  each  is  equally  buoyant. 
Then  each  one  should  be  divided  into  about  fifteen  pieces, 
and  each  fragment  separately  tested.  If  all  the  pieces  float, 
even  after  firm  compression,  the  inference  would  be  that 
respiration  had  been  very  perfectly  performed.  If  they  sink, 
it  should  be  noticed  whether  this  occurs  rapidly  or  slowly. 
The  lungs  should  then  be  tested  separately  —  one  may  sink, 
while  the  other  (commonly  the  right)  may  float.  Supposing 
both  to  sink,  they  should  each  be  divided  into  pieces,  and 
each  one  tried  separately,  as  before  described.  If  all  the 
pieces  sink,  the  inference  is  that,  although  the  child  may 
have  survived  its  birth  for  a  short  time,  there  is  no  evidence 
of  its  having  breathed. 

Much  useless  discussion  has  occurred  as  to  the  true  value 
of  the  hydrostatic  test  in  a  case  of  infanticide.  It  must  be 
evident,  on  a  careful  consideration  of  the  principles  involved 
in  this  test,  that  it  can  only  prove  the  aeration  or  the  non- 
aeration  of  the  child's  lungs  ;  it  does  not  necessarily  prove 
respiration,  although  it  establishes  a  very  strong  probability 
of  it.  Moreover,  as  respiration  may  take  place  —  partially, 
at  least,  as  in  certain  cases  of  face  presentation,  where  the 
labor  has  been  protracted  and  the  vagina  widely  dilated  — 
while  the  head  was  yet  in  the  uterus  or  in  the  vagina,  and 
frequently  after  the  head  has  been  born,  but  before  the 
complete  extraction  of  the  body,  it  follows  that  the  hydro- 


INFANTICIDE.  243 

static  test  can  never  prove  a  live  birth,  but  merely  that  the 
child  had  breathed,  and  therefore  was  alive  at  or  about  the 
time  of  its  birth. 

Two  objections  have  been  offered  against  the  hydrostatic 
test  which  deserve  notice. 

I.  That  the  lungs  may  float  although  the  child  viay  not 
have  breathed — («)  from  artificial  inflation  ;  (b)  from  putre- 
faction ;  {c)  from  emphysema. 

(a)  Artificial  Inflation. — In  reply  to  this  objection  it  may 
be  stated  that  it  is  extremely  difficult  to  distend  the  whole 
lung  artificially  through  the  mouth,  even  if  a  tube  and  bel- 
lows be  employed  ;  most  of  the  air  will  be  found  to  have 
passed  into  the  stomach.  Besides,  the  force  of  the  objec- 
tion seems  to  be  met  by  the  fact  that,  in  a  case  of  child 
murder,  the  great  object  of  the  woman  and  her  ac- 
complices is  to  make  it  appear  that  the  child  was  born 
dead ;  they  would,  therefore,  hardly  be  likely  to  adopt 
measures  that  would  suggest  a  strong  probability  of  a 
live  birth. 

It  must,  however,  be  admitted  that,  while  artificial  infla- 
tion of  the  lungs  can  never  be  mistaken  for  perfect  respira- 
tion, it  might  be  confounded  with  imperfect  breathing.  In 
both  cases,  the  lungs  will  be  more  or  less  buoyant  ;  they 
will  crepitate  under  pressure ;  when  divided  into  fragments 
many  of  these  will  float  on  water ;  and  in  some  exceptional 
cases,  firm  pressure  made  on  pieces  of  a  lung  artificially 
inflated  through  a  tube  has  failed  to  cause  these  pieces  to 
sink.  As  a  general  rule,  strong  compression  on  a  fragment 
of  lung  artificially  inflated  by  the  mouth  will  so  completely 
remove  the  air  as  to  cause  it  to  sink  in  water ;  whilst  no 
amount  of  force,  short  of  an  entire  disintegration  of  tissue, 


244  MEDICAL   JURISPRUDENCE. 

will  prevent  the  floating  in  cases  where  natural  respiration 
has  been  fully  performed. 

There  are  other  points,  however,  to  be  noticed  in  making 
the  diagnosis,  viz.,  that  artificial  inflation  does  not  increase 
the  actual  weight  of  the  lungs,  like  respiration,  because  it 
does  not  invite  the  blood  into  them  ;  and  also  that  the  color 
of  the  artificially-inflated  lung  is  a  uniform  cinnabar-red, 
without  any  marbling.  The  explanation  of  this  will  be 
obvious  on  reflection.  Natural  respiration  tends  to  create 
a  vacuum  in  the  lungs,  and  consequently  to  draw  into  them 
the  blood  of  the  pulmonary  arteries,  which  gives  them  the 
comparatively  dark-bluish  and  marbled  appearance  alluded 
to  ;  but  artificial  respiration,  by  which  air  is  forced  into  the 
lungs,  tends  by  the  pressure  of  that  air,  to  exclude  the 
blood,  and  consequently  to  render  the  color  of  the  lungs 
still  lighter  than  before.  A  fragment  of  the  lung  squeezed 
under  water  will  exude  air,  but  no  blood  (Lutaud).  Casper's 
opinion  about  the  matter  is  :  "  When  we  observe  a  sound  of 
crepitation,  without  any  escape  of  blood-froth  on  incision, 
laceration  of  the  pulmonary  air  cells  with  hyperemia,  bright 
cinnabar-red  color  of  the  lungs  without  any  marbling,  and 
perhaps  air  in  the  artificially  inflated  stomach  and  intestines, 
we  may,  with  certainty,  conclude  that  the  lungs  have  been 
artificially  inflated." 

{b)  Putrefaction. — It  is  admitted  that  the  lungs  of  a  dead- 
born  child  will  float,  as  the  result  of  the  gases  generated  by 
putrefaction.  The  air  thus  evolved  is  not  contained  in  the 
air  cells  of  the  lungs,  but  in  the  cellular  tissue,  and  chiefly 
between  the  lobes  and  lobules.  Moreover  it  collects  in 
rows  or  bubbles,  which  are  much  larger  than  the  air  vesicles, 
prominent  and  disappearing  entirely  under  slight  pressure. 
At  the  same  time,  the  lungs  themselves  present  other  evi- 


INFANTICIDE.  245 

dences  of  putrefaction,  such  as  a  greenish  color,  a  fetid 
odor,  and  diminished  consistence.  If  a  portion  be  cut  out 
from  the  interior  of  the  lung  it  will  be  found  to  sink  in 
water.  Again,  if  the  air  be  squeezed  out  of  a  portion  of 
the  lung  it  will  no  longer  float  in  water.  There  is  also  a 
want  of  crepitation  in  a  putrescent  lung. 

The  exact  period  when  the  fetal  lungs  undergo  putre- 
faction cannot  be  fixed ;  but  it  is  known  that  it  is  delayed 
much  longer  than  in  the  other  organs  of  the  child  ;  con- 
sequently, in  a  doubtful  case,  if  the  other  organs  give  no 
evidence  of  decomposition  we  may  be  certain  that  the 
buoyancy  of  the  lungs  is  not  owing  to  putrefaction.  After 
complete  decomposition  the  lungs  again  sink  in  water. 
There  ought  to  be  no  difficulty  in  distinguishing  between 
the  buoyancy  of  respiration  and  that  resulting  from  putre- 
faction, in  employing  the  hydrostatic  test. 

(c)  Emphysema. — This  was  formerly  regarded  as  a  dis- 
eased (congenital)  condition  of  the  lungs,  which  caused 
them  to  float  in  water  in  the  absence  of  respiration  ;  but  its 
existence  is  considered  as  questionable.  Casper's  decided 
opinion  is  that,  "  as  yet  not  one  single  well-observed  and 
incontestable  case  of  emphysema  developing  itself  spon- 
taneously within  the  fetal  lungs  is  known ;  and  it  is,  there- 
fore not  permissible  in  forensic  medicine  to  ascribe  the 
buoyancy  of  the  lungs  of  new-born  children  to  this  cause." 

II.  That  the  lungs  may  sink  in  water,  although  the  child 
may  have  breathed  and  lived. 

(a)  From  disease,  as  pneumonia,  congestion  and  atelec- 
tasis pulmonum.  These  would  increase  the  density  of  the 
pulmonary  tissue,  and  cause  it  to  sink  in  water.  But  the 
first  two   conditions   are   extremely  rare   in   the   new-born 


246  MEDICAL    JURISPRUDENCE. 

child,  and  the  latter  is  to  be  regarded  as  simply  the 
original  fetal,  undeveloped  condition  of  the  lung  (Casper, 
Meigs).  If  ever  found  they  can  be  readily  recognized  by 
their  general  appearances,  and  also  by  dividing  the  lungs 
into  pieces  and  finding  that  some  of  the  fragments  will 
float.  In  the  case  of  congestion,  if  a  piece  of  the  lung  be 
squeezed  so  as  to  remove  the  blood,  it  will  be  found  to  float. 

(b)  In  those  cases  in  which  the  child  has  survived  for 
some  time,  but  the  respiration  is  so  feeble  as  not  to  inflate 
the  lungs,  the  hydrostatic  test  will  generally,  though  by  no 
means  always,  discover  the  presence  of  air  in  a  few  of  the 
pieces  of  the  lungs,  when  these  have  been  divided.  In  case 
every  fragment  sinks  this  test  can,  of  course,  render  no 
assistance,  a  circumstance  which  is  certain  to  be  regretted, 
inasmuch  as  it  does  not  permit  us  always  to  ascertain  the 
truth. 

The  general  deductions  from  the  two  foregoing  objec- 
tions are  the  following : 

1.  The  lungs  float  (i)  from  natural  respiration  ;  (2)  from 
artificial  inflation  ;  (3)  from  putrefaction  ;  (4)  from  emphy- 
sema (possibly).  Therefore  the  mere  buoyancy  of  the 
lungs  is  not,  of  itself,  positive  proof  of  respiration ;  but,  with 
proper  precautions,  the  test  may  be  depended  upon. 

2.  The  lungs  sink  (i)  from  total  want  of  respiration; 
(2)  from  feeble  or  imperfect  respiration ;  (3)  from  disease. 
Hence,  the  mere  sinking  of  the  lungs  in  water  is  not  of 
itself  a  positive  evidence  that  the  child  has  not  breathed ; 
but  with  due  precautions  it  may  be  regarded  as  a  safe  test. 

As  the  hydrostatic  test  is  of  such  importance  in  cases 
of  infanticide,  great  carefulness  should  be  observed  in  its 
employment.  The  chest  should  be  properly  opened,  and 
the  position,  size,  color,  etc.,  of  the  lungs  accurately  noted. 


INFANTICIDE.  24/ 

The  great  vessels  are  then  to  be  tied  and  cut  at  their  roots. 
The  trachea  is  to  be  divided  as  close  as  possible  to  the 
lungs  ;  these  are  next  to  be  taken  out,  together  with  the 
heart  and  thymus  gland,  and  closely  examined  for  disease 
or  putrefaction,  also  for  crepitation  on  pressure.  A  suitable 
vessel,  containing  fresh  water  at  60°  F.,  should  be  provided. 
It  is  important  to  attend  to  the  temperature  of  the  water, 
since  its  buoyant  power  varies  considerably  between  40°  F. 
and  212°.  For  the  sake  of  uniformity  the  mean  tempera- 
ture of  60°  should  always  be  employed.  For  a  similar 
reason  fresh  and  not  salt  water  ought  to  be  used.  The  lungs, 
together  with  the  trachea  and  bronchi,  are  then  to  be  placed 
in  the  water,  and  it  should  be  noticed  whether,  and  how, 
they  float  or  sink.  The  lungs  should  then  be  separated 
from  the  heart  and  from  each  other,  and  accurately  weighed. 
They  should  again  be  placed  separately  in  the  water  and 
the  result  noticed.  If  one  only  floats,  note  which  one  it  is. 
Each  lung  should  then  be  cut  up  into  about  fifteen  pieces, 
and  each  piece  submitted  to  the  test.  They  should  next  be 
subjected  to  suitable  compression,  by  enclosing  them  within 
the  folds  of  a  towel  and  pressure  applied  ;  after  which  they 
should  again  be  put  into  the  water,  and  the  result  noted  as 
to  whether  they  continue  to  float  or  not. 

There  are  a  number  of  striking  peculiarities  in  the  circu- 
latory organs  of  the  fetus,  which  are  modified  or  entirely 
lost  after  respiration  is  estabHshed.  A  knowledge  of  these 
changes  is  therefore  of  importance  in  a  case  of  infanticide. 
The  evidence  to  be  derived  from  the  changes  in  the  heart 
and  fetal  vessels  comprises  the  examination  of  \h&  foramen 
ovale,  the  ductus  artei'iosus,  the  ductus  venosus,  and  the  um- 
bilical cord.     Although  as  a  general  rule  the  closure  of  the 


248  MEDICAL   JURISPRUDENCE. 

three  first-named  openings  takes  place  at  birth  or  soon  after, 
yet  in  many  instances  it  occupies  a  considerable  time,  so 
that  in  cases  of  infanticide  the  test  is,  practically,  of  little  or 
no  value. 

The  foramen  ovale  is  the  opening  between  the  two 
auricles  of  the  fetal  heart,  through  which,  before  respira- 
tion, the  blood  passes  directly  from  the  right  to  the  left  side 
of  that  organ.  It  usually  closes  at  birth,  or  very  soon  after, 
but  instances  are  known  where  it  continues  open  up  to 
adult  years,  and  even  throughout  life. 

The  ductus  arteriosus  is  a  vessel  about  half  an  inch  long, 
which  in  the  fetus  forms  a  direct  communication  from  the 
right  ventricle  to  the  aorta ;  it  may,  in  fact,  be  regarded  as 
a  direct  continuation  of  the  pulmonary  artery  to  the  aorta. 

The  effect  of  this  arrangement  is  that  most  of  the  blood 
from  the  right  side  of  the  heart,  instead  of  being  propelled 
to  the  lungs  through  the  right  and  left  branches  of  the  pul- 
monary artery,  is  sent  directly  to  the  aorta,  and  thence  into 
the  general  circulation.  The  branches  of  the  pulmonary 
artery,  in  the  fetal  state,  are  small,  inasmuch  as  they  trans- 
mit but  little  blood. 

As  soon  as  respiration  commences,  the  ductus  arteriosus 
begins  to  contract  —  at  first  at  its  aortic  extremity,  and 
gradually  throughout  its  caliber,  until,  finally,  the  whole 
vessel  dwindles  down  to  an  impervious  cord.  During  this 
same  period  the  branches  of  the  pulmonary  artery  increase 
in  size,  in  order  to  transmit  the  due  supply  of  blood  to  the 
lungs,  which  are  now  performing  their  proper  function. 
The  closure  of  the  duct,  although  usually  a  proof  of  a  living 
birth,  is  by  no  means  uniformly  so ;  neither  is  its  open  con- 
dition a  positive  evidence  of  a  dead  birth,  since  its  closure 
is  gradual  and  frequently  protracted. 


INFANTICIDE.  249 

The  ductus  venosus  arises  from  the  umbilical  vein,  and 
opens  into  the  ascending  vena  cava.  It  is  found  in  the 
posterior  part  of  the  longitudinal  fissure  of  the  liver.  Its 
closure  is  apt  to  occur  rather  sooner  than  the  other  open- 
ings before  alluded  to  ;  but  it  is  quite  uncertain  as  a  sign  of 
a  live  birth. 

The  umbilical  vessels  consist  of  a  vein  and  two  arteries. 
The  former  conveys  the  blood  aerated  in  the  placenta  to  the 
fetus,  passing  in  at  the  umbilicus  ;  and  proceeding  onward 
it  divides,  one  part  going  into  the  liver  and  the  other  part 
going  through  the  ductus  vetiosus  into  the  ascending  vejia 
cava,  and  so  carrying  purified  blood  to  the  right  auricle  of 
the  heart.  The  two  umbilical  arteries  are  continuations  of 
the  hypogastrics  ;  they  convey  the  effete  blood  out  of  the 
body,  through  the  navel,  back  again  to  the  placenta,  there 
to  be  renewed.  After  birth,  when  the  route  of  the  circula- 
tion undergoes  such  a  complete  change,  these  vessels  be- 
come closed  and  obliterated  ;  but  the  exact  time  when  the 
closure  takes  place  is  hardly  more  certain  than  in  the  case 
of  the  other  fetal  channels. 

The  desiccation  of  the  umbilical  cord  affords  valuable  evi- 
dence of  a  live  birth,  especially  if  the  child  has  survived 
several  days.  The  cord  is  usually  of  a  bluish,  pearly-white 
color,  about  the  thickness  of  a  finger ;  and  within  twelve  to 
twenty-four  hours  after  birth  loses  its  polish,  becoming  dry 
and  flaccid.  It  is  generally  cut  and  tied  about  three  inches 
from  the  umbilicus,  at  the  time  of  the  birth.  The  process 
of  desiccation  commences  at  the  severed  end  ;  in  the  course 
of  twenty-four  hours  it  reaches  to  within  half  an  inch  of  the 
navel,  this  portion  still  remaining  pulpy,  and  of  an  amber 
color.  About  this  time  the  skin  of  the  abdomen  around 
the  umbilicus  becomes  red  and  swollen,  and  is  pushed  up 

21 


250  MEDICAL    JURISPRUDENCE. 

around  it  in  the  shape  of  an  inverted  cone.  During  the 
second  and  third  day  the  cord  gradually  withers  and  dies, 
becoming  flattened  and  twisted,  and  suppuration  begins  on 
the  still  moist  portion  attached  to  the  navel.  A  line  of 
demarcation  is  seen  forming ;  and  on  the  fourth  day  the 
free  end  of  the  cord  becomes  of  a  yellowish-brown  or  black 
color,  and  has  the  appearance  of  transparent  glue.  The 
separation  of  the  cord  usually  occurs  on  the  fourth,  fifth, 
and  sixth  days  —  the  majority  of  cases  being  on  the  fifth. 
Occasionally,  the  separation  takes  place  some  days  later. 

The  existence  of  an  inflammatory  zone  about  the  umbili- 
cus is  one  of  the  signs  of  importance  in  judging  whether  an 
infant  has  lived  after  birth.  In  one  case  Dr.  Kirk,  of  Edin- 
burgh, found  such  a  zone  and  gave  judgment  that  the  child 
had  lived.  As  the  result  of  subsequent  investigation  of  sev- 
eral cases,  he  came  to  the  conclusion  that  if  a  child  lives  an 
hour  after  birth  there  will  be  a  slight  circle  of  inflamed  tissue 
about  the  insertion  of  the  cord  ;  this  zone  becomes  more 
pronounced  every  hour  after  birth. 

Although  the  separation  of  the  cord  is  a  vital  act  and 
can  occur  only  in  a  living  child,  its  desiccation  may  take 
place  equally  in  a  dead  child,  although  it  occupies  a  much 
longer  time  in  the  latter,  sometimes  not  commencing  for 
several  days  after  birth.  But  the  important  point  of  distinc- 
tion between  the  two  is  that  spontaneous  separation  of  the 
cord  never  occurs  in  a  dead-born  child ;  it  merely  withers 
and  dries  up,  but  remains  attached.  Hence,  the  desiccation 
and  separation  of  the  cord  and  the  subsequent  cicatrization 
afford  positive  proof  that  the  child  was  born  ahve,  and  had 
continued  to  live  some  days  after  its  birth. 

In  the  fetus  the  liver  is,  relatively,  enormously  large  and 
very  vascular,  doubtless  in  consequence  of  the  important 


INFANTICIDE.  25 1 

function  it  has  to  perform  in  connection  with  the  circulation 
of  the  blood.  Meckel  found  the  absolute  weight  of  the 
liver  to  diminish  until  the  end  of  the  first  year  of  extra- 
uterine life.  In  five  new-born  children  the  liver  was  found 
to  be  one  fourth  heavier  than  in  five  other  children  of  eight 
to  ten  months  old. 

The  stomach  and  intestinal  canal  may  sometimes  afford 
positive  proofs  of  a  live  birth,  from  the  discovery  therein  of 
certain  matters  —  liquid  and  solid  —  such  as  blood,  milk, 
farinaceous  and  saccharine  articles.  The  two  former  sub- 
stances may  be  identified  by  the  microscope,  which,  how- 
ever, fails  to  distinguish  between  human  and  cow's  milk  ; 
but  the  detection  of  colostrum  corpuscles  in  the  contents  of 
the  child's  stomach  would  be  good  evidence  that  the  milk 
was  from  a  woman  very  recently  delivered.  Another  test 
for  the  presence  of  milk  is  that  of  Trommer  for  milk-sugar. 
The  suspected  substance,  properly  diluted,  is  treated  with  a 
few  drops  of  a  weak  solution  of  copper  sulphate,  sodium 
hydroxid  added  in  excess,  and  then  boiled  ;  a  red  precipi- 
tate indicates  the  presence  of  sugar. 

Starchy  matters  may  be  easily  recognized  by  the  appli- 
cation of  tincture  of  iodin,  which  imparts  a  deep  blue  color  ^ 
and  also  by  microscopic  examination,  which  may  even  iden- 
tify the  particular  variety  of  starch  —  as  arrowroot,  potato 
starch,  etc. 

The  presence  of  blood  in  the  stomach  is  not  necessarily 
evidence  that  the  child  was  born  alive,  since  it  is  possible 
that  it  might  have  been  drawn  into  the  throat  from  the 
maternal  discharges,  during  the  passage  of  the  head  through 
the  outlet,  and  before  it  had  breathed. 

The  presence  of  meconium  in  the  stomach,  like  that  of 
blood,  is  not  a  positive  indication  of  a  live  birth,  because 


252  MEDICAL    JURISPRUDENCE. 

the  child  may  have  drawn  it  into  the  stomach  and  air  pas- 
sages by  aspiration,  in  the  passing  of  the  head  over  this 
substance,  through  the  outlet.  Meconium  is  recognized 
by  its  dirty,  dark -green  color  and  want  of  fecal  odor.  The 
microscope  shows  it  to  contain  ciystals  of  cholesterol, 
epithelial  scales,  masses  of  green  coloring  matter  of  bile 
and  granules. 

The  absence  of  meconium  from  the  intestines  (where  it 
is  usually  found  at  birth),  and  also  the  absence  of  urine 
from  the  bladder,  are  not,  necessarily,  evidences  that  the 
child  has  been  born  alive,  since  these  liquids  may  be  dis- 
charged during  the  act  of  birth. 

II.  Causes  of  Deatli  in  the  Neiv-born  Child. — Having  dis- 
posed of  the  Question  I. — Has  the  child  been  born  alive? — 
we  are  now  prepared  to  discuss  the  second,  viz.  :  What  was 
the  cause  of  its  death  ?  These  causes  are  various.  They 
may  be  considered  under  the  heads  of  such  as  act  during 
birth,  and  such  as  act  subsequently  ;  also,  such  as  are  acci- 
dental, and  such  as  are  criminal.  It  is  the  latter  only  that 
can  be  connected  with  a  charge  of  infanticide. 

In  an  investigation  of  this  character  it  should  be  remem- 
bered that  many  children  are  still-born,  the  proportion 
being  one  in  every  eighteen  or  twenty  of  legitimate  chil- 
dren. Among  illegitimate  children  the  proportion  is  much 
greater  —  probably  one  in  ten  (Taylor).  As  before  men- 
tioned, this  throws  the  burden  of  proof  of  a  live  birth,  in  a 
case  of  infanticide,  on  the  prosecution,  as  the  law  assumes 
in  all  such  cases  that  the  child  was  born  dead. 

I.  Causes  Acting  During  Birth. — (i)  Compression  of,  and 
by,  the  umbilical  cord.  This  may  happen  in  breech  or  foot 
presentations ;    also  when  the  cord  is  prolapsed  in  these,  or 


INFANTICIDE.  253 

in  head  presentations.  In  such  labors  it  is  well  understood 
that  unless  the  cord  is  speedily  relieved  of  pressure,  the 
child  will  perish.  Another  cause  of  compression  arises 
from  the  cord  being  wound  round  the  child's  neck.  This  is 
quite  a  frequent  complication,  according  to  Elsasser,  being 
found  as  often  as  one  in  every  five  cases.  In  the  latter  in- 
stance death  may  proceed  either  from  the  constriction  of  the 
child's  neck,  by  the  cord  causing  congestion  of  the  brain, 
or  from  the  interruption  of  the  flow  of  blood  in  the  cord 
itself,  owing  to  the  strain  upon  it.  The  effects  of  the  con- 
striction of  the  neck  by  the  cord  are  not  precisely  similar 
to  those  of  strangulation  in  a  child  that  has  breathed  ; 
and  inasmuch  as  children  are  not  infrequently  purposely 
strangled  after  the  head  is  born,  and  before  the  rest 
of  the  body  is  expelled,  it  is  important  to  understand  if 
there  are  any  means  of  distinguishing  between  the  two 
cases. 

In  the  last-mentioned  case,  if  the  child  had  not  breathed 
when  the  strangulation  was  effected,  there  would  be  no 
means  of  distinguishing  it  from  death  occasioned  by  con- 
striction of  the  cord,  except  where  marks  of  the  ligature, 
have  been  left  upon  the  neck  of  the  child.  The  question 
then  is.  Does  the  cord  ever  leave  such  a  mark  upon  the 
neck  ?  The  cases  are  extremely  rare  in  which  the  cord 
leaves  any  mark  identical  with  that  produced  by  a  ligature 
in  actual  strangulation.  Elsasser  states  that  of  327  cases 
of  labor  in  which  the  cord  was  twisted  around  the  child's 
neck,  there  was  one  fold  of  it  in  228  cases  ;  two  folds  in  83 
cases  ;  three  in  13  cases,  and  four  in  4  cases  ;  yet  in  the 
whole  series  there  was  not  a  single  instance  in  which  the 
least  mark,  impression,  or  ecchymosis  was  visible.  In  some 
cases    the  cord   was  so  tightly  wound    round    both    neck 


2  54  MEDICAL   JURISPRUDENCE. 

and  body  that  it  was  necessary  to  divide  it  before  delivery 
could  be  accomplished.  There  are  some  instances  re- 
ported by  trustworthy  authorities,  in  which  the  umbilical 
cord  has  left  very  positive  marks  upon  the  neck  of  the 
child,  sometimes  a  mere  furrow  or  depression,  and  again 
distinct  lines  of  a  red  or  blue  color,  sometimes  single,  and 
at  others  two  or  three  parallel  ones.  It  is,  however,  ex- 
tremely doubtful  if  a  true  ecchymosis  or  extravasation  of 
blood  ever  results  from  compression  of  the  neck  by  the 
cord ;  certainly  there  can  be  no  abrasion  of  the  cuticle,  as 
is  frequently  observed  in  cases  of  strangulation  by  a  rough 
string  or  cord.  Even  a  livid  mark  around  the  neck  is  not 
necessarily  caused  by  an  effusion  of  blood,  and  such  marks 
will  often  be  found  to  disappear  on  the  establishment  of 
respiration.  It  should  also  be  remembered  that,  in  fat 
children  especially,  if  the  neck  be  short  and  the  body  has 
been  kept  in  a  cold  place,  furrows  and  ridges  may  be 
formed  in  the  folds  of  the  skin,  which,  to  an  ordinary  ob- 
server, might  be  suggestive  of  strangulation. 

Should  a  ligature  be  actually  found  around  a  child's  neck, 
there  could,  of  course,  be  no  longer  any  question  about  the 
impression  not  being  due  to  the  umbihcal  cord.  The  usual 
defense  in  such  a  case  is  that  the  ligature  was  placed  there 
by  the  woman  herself,  for  the  purpose  of  assisting  her  de- 
livery, and  no  medical  evidence  can  disprove  such  a  state- 
ment. If  the  strangulation  has  been  accomplished  by  the 
hand,  the  impression  left  will  usually  be  very  distinct  and 
suggestive,  and  totally  different  from  that  produced  by  the 
navel  string,  which,  at  most,  leaves  a  broad,  smooth  inden- 
ture, with  soft  edges. 

The  cord  sometimes,  by  being  coiled  around  the  limbs, 
and  body  of  the  child,  before  birth,  produces  deep  depres- 


INFANTICIDE.  2  55 

sions  in  the  skin.     Even  an  amputation  of  a  limb  has  been 
observed  as  an  effect. 

(2)  Protracted  delivery  is  not  infrequently  the  cause  of 
the  child's  death,  especially  in  first  labors.  It  may  be  as- 
cribed either  to  congestion  of  the  brain,  resulting  from  the 
compression  of  the  head,  or  to  interruption  to  the  circulation 
in  the  umbilical  cord,  through  pressure,  before  respiration 
can  be  performed.  In  primiparous  cases,  the  labor  is  very 
apt  to  be  protracted,  and  the  child  large,  often  requiring  the 
application  of  the  forceps.  In  death  from  this  cause,  the 
head  will  usually  be  found  much  elongated,  with  evidences 
of  considerable  pressure,  and  having  a  large  caput  succeda- 
neum.  The  autopsy  will  disclose  congestion  of  the  cerebral 
vessels. 

(3)  Debility.  —  A  child  may  be  born  either  prematurely 
or  at  full  term,  and  soon  die  from  constitutional  weakness, 
either  inherited  or  produced  by  causes  acting  upon  it  before 
birth.  In  such  feeble  children  a  veiy  slight  cause  is  suffi- 
cient to  destroy  life.  Such  cases  are  recognized  by  the 
immature  condition  of  the  body,  and  the  absence  of  all  other 
causes  of  death. 

(4)  Hemorrhage  from  the  cord  is  sometimes  the  cause  of 
death  in  the  newborn  child,  either  from  accidental  rupture 
during  the  birth,  or  after  its  severance.  The  sudden  prema- 
ture separation  of  the  placenta  will  produce  the  same  result. 
The  child,  under  these  circumstances,  will  exhibit  a  blanched 
and  waxy  appearance,  together  with  a  paleness  and  dryness 
of  the  internal  organs,  particularly  of  the  heart  and  lungs. 
This  will  not,  however,  hold  good  where  putrefaction  of  the 
body  is  advanced.  The  hemorrhage  may  be  accidental,  or 
the  result  of  criminal  design.  In  either  case  it  may  have 
arisen  from  laceration  of  the  cord,  or  from  an  omission  to 


256  MEDICAL   JURISPRUDENCE. 

tie  it  after  birth.  Dr.  Reese  witnessed  one  case  of  fatal 
hemorrhage  of  the  cord  some  days  after  birth,  in  spite  of 
every  effort  to  control  it.  Casper,  with  his  large  experience, 
states  that  he  never  met  with  a  fatal  case  of  hemorrhage  of 
the  cord,  although  he  had  witnessed  several  where  it  had 
been  cut  off  close  to  the  navel. 

It  would  appear,  from  numerous  cases  reported,  that  fatal 
hemorrhage  is  less  apt  to  follow  when  the  cord  is  ruptured 
than  when  it  is  cut,  probably  for  the  same  reason  that  a  torn 
artery  is  less  likely  to  bleed  than  one  severed  with  a  knife. 
According  to  Wharton  and  Stille,  it  is  the  habit  of  the 
Indian  squaws  to  break  the  cord,  and  then  bind  the  fetal 
end  with  a  strip  of  bark.  Numerous  instances  are  also 
mentioned  of  rapid  delivery  in  women  in  an  upright  posi- 
tion, where  the  child  has  suddenly  escaped  from  the  mother 
and  fallen  to  the  ground,  rupturing  the  navel  string,  yet 
without  any  bleeding  of  con.sequence.  We  know  that  the 
instinct  of  some  animals  leads  them  to  divide  the  cord  with 
their  teeth,  while  in  others  it  is  ruptured  either  by  the  fall 
of  the  young  while  the  mother  is  standing  upright,  or  else 
by  her  suddenly  springing  up  when  delivered  in  a  recum- 
bent position. 

The  usual  length  of  the  umbilical  cord  is  from  eighteen 
to  twenty  inches  ;  but  it  frequently  exceeds  this,  in  one 
instance  amounting  to  fifty-nine  inches  and  in  another  sixty- 
nine  inches.  In  ordinaiy  cases  of  delivery  in  the  upright 
posture,  the  child  may  fall  a  distance  of  twenty-eight  to 
thirty  inches  to  the  ground  without  putting  a  strain  upon 
the  cord.  But  in  most  instances  of  this  nature  this  distance 
would  be  diminished  by  the  woman  instinctively  assuming 
more  or  less  of  a  bending  position  at  the  moment  of  expul- 
sion.     Still,  it  might  happen  that  the  cord  might  be  unusu- 


INFANTICIDE.  2^J 

ally  short,  or  else  wound  round  the  child,  in  which  case  it 
could  easily  be  ruptured.  The  point  at  which  the  rupture 
usually  occurs  is  a  few  inches  from  the  umbilicus.  In  some 
instances  of  sudden  traction,  where  it  does  not  break,  the 
placenta  attached  may  be  dragged  out  by  the  weight  of 
the  child. 

5.  Fractures. — These  are  chiefly  confined  to  the  head  of 
the  child,  and  may  be  produced  during  any  period  of  ges- 
tation, either  accidentally  or  otherwise,  from  blows,  falls,  or 
other  injuries,  such  as  the  kick  of  a  horse,  etc.  Other  bones 
may,  of  course,  be  fractured  by  blows,  or  injuries  sustained 
by  the  mother  during  pregnancy.  Sometimes  when  the 
result  is  not  fatal  to  the  child,  the  marks  of  bony  union  are 
visible  after  birth  ;  but  in  most  such  cases  the  child  perishes 
at  the  time  of  the  injury  and  is  born  prematurely,  so  that 
the  question  of  infanticide  hardly  presents  itself.  Fractures 
of  the  skull  may  occur  accidentally  during  labor,  from  a 
disproportionate  size  of  the  child's  head,  or  some  deformity 
or  osseous  tumor  of  the  mother's  pelvis.  As  such  cases 
usually  require  instrumental  aid,  the  injury  may  have  been 
unavoidably  caused  by  the  forceps.  Such  fractures,  how- 
ever, are  rare,  on  account  of  the  extreme  mobility  of  the 
cranial  bones  upon  each  other,  which  allows  of  considerable 
pressure  and  reduction  of  the  volume  of  the  head.  In  these 
cases,  as  the  child  may  survive  sufficiently  long  to  breathe, 
it  is  of  importance  to  prove  that  the  fracture  was  accidental 
and  not  criminal.  In  the  former  case,  the  fracture  is  nearly 
always  on  the  parietal  bones,  sometimes  in  the  frontal,  but 
never  in  the  occipital  bone.  It  is  usually  a  mere  fissure  or 
crack,  very  rarel}^  a  depression,  unless  great  violence  had 
been  employed.  In  cases  of  criminal  violence,  the  fracture 
would  probably  be  stellated  or  depressed,  the  bones  often 


258  MEDICAL   JURISPRUDENCE. 

being  driven  deeply  in,  and  the  brain  even  protruding,  to- 
gether with  laceration  of  the  scalp  and  other  marks  of  vio- 
lence. In  a  case  in  which  the  criminal  fracture  happened 
to  be  only  slight,  it  might  be  impossible  to  distinguish  it 
from  one  resulting  accidentally  at  the  birth.  It  should  also 
be  remembered  that  very  extensive  fractures  of  the  child's 
skull  may  result  from  criminal  violence,  without  any  visible 
trace  of  injury  to  the  scalp.  There  is  also  a  possibility  of 
mistaking  a  defective  ossification  of  the  bones  of  the  cranium 
for  fracture.  This  defect  occurs  usually  in  the  parietal 
bones,  and  is  caused  by  a  deficiency  in  the  bony  spiculae, 
which  is  replaced  by  a  membrane  that  fills  up  the  gap. 
The  edges  of  the  bones  are  thin  and  beveled,  and  show  no 
marks  of  injury.  A  true  fracture  is  evidenced  by  a  red  line, 
seen  on  removing  the  pericranium,  by  the  edges  of  the  bone 
being  jagged  and  bloody,  and  by  the  absence  of  any  mem- 
brane ;  there  is  also  more  or  less  effusion  of  blood  in  the 
neighborhood  of  a  fracture. 

The  cases  that  occasion  the  greatest  difficulty  are  those 
in  which  the  fracture  is  alleged  to  have  resulted  from  the 
fall  of  the  child  to  the  ground,  in  consequence  of  a  sudden 
deliveiy  while  the  mother  was  in  the  erect  position.  Such 
cases,  although  comparatively  rare,  occur  sufficiently  often 
to  require  attention.  They  present  no  special  marks  by 
which  they  can  be  distinguished  from  cases  of  criminal 
violence.  Some  writers  deny  the  possibility  of  this  acci- 
dent, but  others,  including  Casper,  admit  an  occasional 
occurrence.  Dr.  Reese  made  experiments  on  the  bodies 
of  twenty-five  dead  infants,  letting  them  fall  from  a  height 
of  thirty  inches  upon  a  hard  pavement.  One  parietal 
bone  was  found  fractured  in  sixteen  cases  ;  both  parietals 
in   six  cases  ;    once    the    parietal   and    frontal ;    once   the 


INFANTICIDE.  259 

frontal  ;  and  once  the  occipital.  The  fractures,  in  most 
cases,  occurred  about  the  parietal  protuberances.  It 
should  be  remembered  that,  it  is  easier  to  fracture  the 
skull  of  a  live  infant  than  that  of  a  dead  one.  So,  also,  it 
has  been  ascertained  that  when  firm  pressure  by  the  thumbs 
and  fingers  is  made  upon  the  head  of  a  new-born  dead  child, 
out  of  fifteen  experiments,  in  seven  long  fractures  of  one  or 
other  parietal  bones  resulted ;  in  the  other  cases  the  result 
was  merely  a  depression  of  the  bone.  Hence,  we  must 
conclude  that  the  possibility  of  such  an  accident  should 
always  be  taken  into  consideration,  in  cases  of  concealed 
birth,  when  fractures  of  the  skull  are  discovered. 

2.  Causes  of  Death  after  Birth. — These  are  both  numerous 
and  varied,  (i)  Congenital  malformation  and  disease  may 
exist ;  but  in  most  cases  life  may  endure,  though  for  a  brief 
period,  even  in  monstrosities.  Some  of  these  malformations 
are  remediable,  others  are  not.  If  violence  should  be 
inflicted  upon  such  beings  for  the  purpose  of  destroying 
life,  the  evidences  for  its  discovery  are  similar  to  those 
employed  in  other  cases. 

(2)  Exposure.  —  Under  this  head  may  be  included  all  the 
different  cases  of  abandonment  of  the  new-born  child.  The 
new-born  infant  quickly  perishes  if  not  properly  cared  for 
in  the  way  of  food  and  clothing.  Authorities  generally 
agree  that  deprivation  of  nourishment  for  over  twenty-four 
hours  is  likely  to  prove  fatal.  Fodere  states  the  greatest 
length  of  time  to  be  one  or  two  days.  Yet  there  are  cases 
on  record  where  the  infant  survived  three  days  without  any 
food,  and  exposed,  at  the  same  time,  to  the  variations  of 
the  temperature. 

The  proofs  of  death  from  exposure  to  cold  are  by  no 
means  positive  unless  the  body  be  discovered  frozen  stiff, 


26o  MEDICAL    JURISPRUDENCE. 

discolored  and  shriveled,  naked  or  scantily  covered,  in  a 
cold  place,  buried  under  stones  or  earth,  its  lungs  affording 
evidence  of  previous  respiration,  the  internal  vessels  gorged 
with  blood,  while  the  external  ones  are  empty,  the  brain 
deeply  congested,  as  also  the  lungs  and  right  heart  (Fodere). 
Under  such  circumstances  and  in  the  absence  of  all  causes 
of  death  it  may  be  ascribed  to  cold. 

The  signs  of  death  from  starvation  are  to  be  sought  for 
in  the  same  general  way.  These  are  an  emaciated  and 
shriveled  body ;  a  pale  and  wrinkled  countenance,  expres- 
sive of  pain  ;  dry,  tough,  and  yellowish  skin  ;  the  mouth, 
tongue,  and  fauces  also  dry ;  the  stomach  and  intestines 
empty  and  contracted ;  gall-bladder  enlarged  and  bile 
usually  found  in  the  alimentary  canal ;  stomach  inflamed  in 
places  ;  the  heart  flaccid  and  the  great  vessels  almost  empty. 
Cases  of  infanticide  by  absolute  starvation  are  rare.  In 
order  to  establish  the  charge,  it  must  be  shown  that  the 
woman  willfully  kept  the  child  without  food,  and  with  a 
criminal  design.  Mere  neglect  or  imprudence  in  not  suf- 
ficient. In  a  suspected  case  of  this  kind,  it  is  recommended 
to  examine  the  contents  of  the  stomach  for  starch  and 
other  varieties  of  food. 

There  is  no  doubt  that  many  young  children  are  pur- 
posely exposed  to  the  danger  of  starvation  by  putting  them 
out  to  be  nursed  on  improper  as  well  as  scanty  food,  as 
witnessed  in  the  wretched  system  of  baby-farming. 

(3)  Wounds  and  Injuries. — These  are  frequently  the  cause 
of  death  in  new-born  children  ;  they  usually  prove  rapidly 
fatal,  and,  as  a  rule,  leave  no  signs  of  inflammation  or  its 
results  to  indicate  that  the  wound  was  made  during  life. 
The  best  evidence  of  the  ante-mortem  character  of  the 
wound  is  the  presence  of  coagula  under  and  around  it. 


INFANTICIDE.  26 1 

These  indicate  that  the  circulation  was  going  on  at  the 
time ;  but  if  the  effused  blood  be  liquid,  the  presumption 
is  that  the  injuries  were  inflicted  after  death,  and  while  the 
body  was  yet  warm.  An  accidental  wound  upon  the  child 
(usually  on  the  arm  or  leg)  might  be  made  by  the  knife  or 
scissors  employed  in  cutting  the  cord ;  but  in  such  a  case 
there  should  be  proof  that  the  cord  had  been  really  cut, 
and  not  ruptured. 

Penetrating  and  punctured  ivoiinds,  of  apparently  trifling 
character,  may  easily  prove  fatal  to  a  new-born  child.  Thus, 
punctures  made  by  a  needle  or  stiletto  into  the  fontanelles, 
between  the  vertebrae  or  under  the  orbit,  are  almost  sure  to 
destroy  life.  Beck  mentions  the  case  of  a  midwife  who  was 
executed  in  Paris  for  killing  several  children  by  plunging  a 
needle  into  the  head  as  it  presented  itself  at  the  mouth  of 
the  womb.  He  also  cites  the  case  reported  by  Dr.  Under- 
wood, of  a  child  who  died  in  convulsions  which  could  not 
be  traced  to  any  cause  until  after  death,  when  a  pin,  that 
had  accidentally  gotten  under  the  child's  cap,  was  found 
inserted  into  the  fontanelle.  The  cause  of  death  in  such 
cases  may  easily  escape  detection.  If  suspected,  the  skin 
should  be  carefully  dissected  off  and  spread  out  before  the 
light,  when  the  finest  puncture  can  be  detected. 

Dislocation  and  fracture  of  the  neck  {tivisting  of  the  neck) 
are  occasional  causes  of  death  in  new-born  children.  Of 
course,  in  such  cases  the  defense  would  ascribe  it  to  acci- 
dent in  the  efforts  to  disengage  the  child  from  the  mother, 
and  the  fact  of  criminal  interference  could  only  be  estab- 
lished by  the  attending  circumstances.  It  should  also  be 
remembered  that  cases  are  recorded  where  other  disloca- 
tions, as  of  the  hip  and  knee,  have  taken  place  before  birth 
as  the  results  of  any  injury  to  the  mother. 


262  MEDICAL   JURISPRUDENCE. 

(4)  Asphyxia  in  its  various  forms  is  the  most  common 
of  all  the  means  of  destroying  the  new-born  child.  Ac- 
cording to  M.  Tardieu,  whose  ample  experience  extended 
over  twenty-four  years,  four  fifths  of  all  the  cases  of  infan- 
ticide that  he  had  examined  were  due  to  some  form  of 
asphyxia. 

Asphyxia  may  be  effected  in  various  ways  —  as  by  suf- 
focation, strangling,  hanging,  or  drowning,  by  smothering 
under  the  bed-clothes,  by  exposure  to  noxious  vapors  or 
gases,  or  by  thrusting  various  substances  into  the  mouth 
and  nose. 

{a)  Suffocation. — This  is  a  frequent  cause  of  accidental 
death  in  new-born  children,  arising  from  neglect  to  remove 
it  from  the  maternal  discharges  or  from  the  bed-clothes, 
or  to  disengage  its  face  from  the  membrane,  or  caul,  which 
is  sometimes  spread  over  it,  or  to  remove  the  mucus  from 
its  mouth  and  throat.  In  some  cases  the  obstruction  is 
caused  by  meconium,  blood,  or  feces  which  have  been 
taken  in  by  aspiration,  in  the  passage  of  the  head  through 
the  outlet,  or  immediately  after  birth.  Such  instances  of 
accidental  suffocation  usually  occur  when  the  woman  is 
delivered  without  any  assistance. 

Suffocation  is  a  very  frequent  criminal  cause  of  death  in 
cases  of  infanticide.  The  facility  with  which  it  can  be  ac- 
complished, and  the  sHght  risk  of  detection,  in  consequence 
of  the  difficulty  of  distinguishing  it  from  an  accident,  doubt- 
less cause  it  to  be  so  often  resorted  to.  A  wet  cloth  simply 
placed  over  the  mouth  or  thrust  into  the  cavity,  either 
before  or  after  respiration,  and  pressure  on  the  child's  chest 
(though  the  latter  might  accidentally  occur  at  birth,  when 
the  head  is  born  and  the  body  is  retained  for  some  time 
and   subjected   to  pressure  in  the  outlet),  foreign  bodies 


INFANTICIDE.  263 

introduced  into  the  mouth  and  throat,  such  as  tow,  hay, 
feathers,  ashes,  etc.  Such  are  the  means  commonly  em- 
ployed for  suffocating  the  child.  In  one  case  a  mass  of 
dough  had  been  forced  down  the  throat  so  as  to  obstruct 
the  larynx  ;  in  another,  the  back  part  of  the  throat  was 
packed  with  wet  sand ;  and  in  a  third,  the  respiratory  pas- 
sages were  filled  with  cinders,  drawn  in  suddenly  by  aspira- 
tion. A  child  may  also  be  suffocated  under  the  bed-clothes, 
or  by  exposure  to  the  noxious  vapors  of  sulphur,  burning 
charcoal,  the  exhalations  of  privies,  etc.,  and  without  leav- 
ing any  trace  of  the  real  cause  of  death. 

Strictly  speaking,  the  child  cannot  be  said  to  be  suffocated 
unless  it  has  first  breathed  ;  yet  in  many  cases  the  death  is 
brought  about  before  respiration  is  established  —  breathing 
is  simply  prevented.  Under  such  circumstances  it  would 
be  impossible  for  the  examiner  to  ascribe  the  death  to  a 
criminal  act,  unless  there  existed  very  evident  marks  of 
undue  violence.  In  every  case  of  infantile  suffocation,  a 
careful  inspection  of  the  respiratory  openings  should  be 
made,  in  order  to  detect  the  presence  of  foreign  bodies.  In 
true  cases  of  suffocation  the  post-mortem  signs  are  those  of 
apnea  generally  —  such  as  congestion  of  the  right  heart  and 
venous  system,  and  also  of  the  brain  ;  but  there  are  present, 
also,  the  punctiform  ecchymoses  under  the  pleura,  pericar- 
dium, endocardium,  peritoneum,  and  bronchi,  so  much 
insisted  on  by  Tardieu.  The  lungs  of  infants,  according  to 
the  best  authorities,  are  not  usually  found  engorged  with 
blood.  Tidy  says  :  "If  the  child  be  vigorous  and  well 
developed,  the  muscular  and  elastic  forces  of  the  arteries 
and  arterioles  will  be  sufficient  to  drive  the  blood  on  after 
the  heart  has  ceased  to  beat  and  respiration  is  prevented. 
Such  lungs  will,  therefore,  be  found  comparatively  bloodless 


264  MEDICAL   JURISPRUDENCE. 

or  anemic,  but  with  a  large  amount  of  emphysema,  or  dila- 
tation and  rupture  of  the  air-cells,  owing  to  the  violent 
attempts  at  inspiration  or  breathing," 

If  the  death  has  resulted  from  pressure  of  the  body 
under  the  bed-clothes,  the  head  will  be  found  flattened,  the 
tongue  protruding,  the  eyes  half  open,  a  frothy  mucus 
escaping  from  the  corners  of  the  mouth,  and  the  excre- 
ments voided. 

{b)  Strangulation.  —  This  is  a  not  infrequent  mode  of 
child-murder.  The  marks  differ  according  to  the  methods 
employed.  Since,  in  criminal  strangulation,  much  more 
violence  is  usually  employed  than  is  necessary,  the  neck 
will  be  very  apt  to  bear  the  impress  of  the  fingers  or  of  the 
ligature  employed,  and  sometimes  of  both.  At  times  there 
may  be  abrasion  of  the  cuticle  from  the  roughness  of  the 
ligature,  and  also  ecchymosis  surrounding  the  marks  of  the 
latter. 

In  all  such  cases  of  infanticide,  the  usual  defense  set  up 
is  that  the  cord  was  placed  upon  the  neck  of  the  child  to 
aid  in  its  deHvery  ;  or  else  it  will  be  attributed  to  the  acci- 
dental encircling  by  it ;  this,  however,  would  be  disproved 
by  the  evidence  of  breathing.  Even  the  marks  of  the 
fingers  upon  the  throat,  indicating  throttling,  will  be  at- 
tempted to  be  explained  by  referring  them  to  the  same  cause. 

The  question  whether  the  marks  of  the  cord  in  strangu- 
lation can  be  imitated  if  it  is  applied  after  death,  must  be 
answered  in  the  affirmative,  provided  it  is  done  very  soon 
after  death,  and  while  the  body  is  yet  warm. 

The  only  difference  between  strangling  and  hanging,  as 
a  mode  of  child-murder,  is  the  oblique  mark  of  the  cord 
about  the  neck  of  the  latter.  Hanging  is  certainly  a  very 
rare  form  of  infanticide, 


INFANTICIDE.  265 

(c)  Drowning. — There  are  no  signs  to  indicate  death  from 
drowning  in  the  body  of  a  child  that  has  not  breathed  ;  yet 
this  form  of  infanticide  has  been  known  to  be  peipetrated 
criminally,  as  when  a  woman  causes  herself  to  be  delivered 
in  a  bath,  so  as  to  to  retain  the  child  under  water,  and  thus 
prevent  its  breathing.  After  respiration,  the  signs  of  drown- 
ing are  the  same  as  in  adults.  Here  the  important  medico- 
legal question  is.  Was  the  child  alive  or  dead  when  thrown 
into  the  water  ?  Generally  it  is  the  latter ;  hence  the  im- 
portance of  an  accurate  inspection  of  the  body  to  ascertain 
the  existence  of  marks  of  violence,  some  of  which  would 
be  positive  evidence  of  antecedent  death,  while  others 
might  possibly  be  ascribed  to  accidental  causes.  In  all 
such  cases  the  throat  and  air  passages  should  be  especially 
investigated  for  foreign  substances. 

It  should  be  remembered  that  a  young  infant  may  easily 
be  drowned  by  the  simple  immersion  of  the  face  in  water. 
Cases  have  occurred  where,  through  unconsciousness,  or 
in  a  very  rapid  delivery,  the  child  is  projected  into  a  com- 
mode half  full  of  water,  where  it  would  certainly  perish  by 
drowning  if  not  soon  rescued.  A  case  of  this  nature  — 
which  did  not,  however,  result  fatally  —  occurred  in  the 
practice  of  Dr.  Reese.  The  accident  may  happen  to  a 
woman  mistaking  the  sensation  caused  by  the  pressure  of 
the  child's  head  on  the  perineum  for  the  feeling  of  a  desire 
to  evacuate  the  bowels.  Yielding  to  this  impulse,  and 
sitting  upon  the  opening  of  a  privy,  a  sudden  pain  will 
eject  the  child  from  the  maternal  parts,  and  in  its  fall  the 
umbilical  cord  will  be  ruptured,  or  else,  in  rare  cases,  the 
placenta  may  be  dragged  out  still  attached,  and  the  child 
will  miserably  perish.  Cases  of  this  sort  occasionally 
occur,  and  it  is   extremely  difficult,  if   not  impossible,  to 


266  MEDICAL   JURISPRUDENCE. 

distinguish  these  from  cases  of  criminal  infanticide,  since 
they  will  both  exhibit  the  same  evidences  of  death  from 
suffocation.  In  a  criminal  case,  however,  the  accompany- 
ing circumstances  may  sometimes  lead  to  the  detection 
of  the  culprit,  as  when  marks  of  blood  are  discovered  in 
her  bed-room,  which  may,  perhaps,  be  traced  to  the  privy ; 
or  when  the  umbiUcal  cord  may  be  discovered  cut  and  not 
ruptured  ;  or  other  circumstances  be  presented  which  would 
render  the  prisoner's  account  inconsistent  with  the  theory  of 
the  accident. 

(d)  Poisoni?ig  is  an  extremely  rare  form  of  infanticide, 
although  it  is  a  frequent  mode  of  destroying  young  chil- 
dren. One  case  is  recorded  of  poisoning  a  child  one  day 
old  with  arsenic  ;  the  mother  was  acquitted  upon  the  plea 
of  puerperal  insanity. 

The  following  general  conclusions  may  be  considered  as 
warranted  from  the  foregoing  considerations:  (i)  Did  the 
death  occur  naturally  ?  (2)  Could  it  have  been  prevented  ? 
(3)  Is  the  mother  guilty  of  not  having  used  proper  precau- 
tion ?  (4)  Was  the  death  caused  by  violence  on  the  part  of 
the  mother?  (5)  If  there  are  marks  of  violence  upon  the 
child,  did  the  mother  inflict  them  ? 

From  what  has  been  said  upon  this  subject,  it  is  evident 
that  medical  testimony  is  not  always  sufficient  of  itself  to 
establish  a  charge  of  infanticide.  So  many  cases,  as  we 
have  seen,  occur  in  which  precisely  the  same  medical  signs 
are  exhibited  in  both  accidental  and  criminal  death  in  new- 
born children,  that  the  attending  circumstances  have  to  be 
depended  upon  in  order  to  come  to  a  decision. 


INFANTICIDE.  267 


MODE  OF  CONDUCTING  AN  EXAMINATION  IN   A   SUSPECTED 
CASE  OF  INFANTICIDE. 

1 .  External.  —  A  careful  external  inspection  of  the  body 
of  the  child  is  first  to  be  made.  Note  the  color,  sex, 
length  (measured  from  vertex  to  feet),  the  presence  or  ab- 
sence of  putrefaction,  wounds,  bruises,  injuries,  stains,  etc. 
Take  the  dimensions  of  the  thorax,  shoulders,  and  head  ; 
also  ascertain  the  weight  and  the  center  of  the  body,  and 
note  the  condition  of  the  umbilical  cord. 

2,  Internal.  —  Observe  the  shape  and  condition  of  the 
thorax ;  the  lungs,  as  to  their  position,  volume,  shape,  and 
color ;  their  absolute  and  specific  weight ;  the  position  of 
the  diaphragm  ;  the  condition  of  the  heart  as  to  the  foramen 
ovale  and  ductus  arteriosus  ;  also  the  ductus  venosus  and 
the  umbilical  vessels.  In  the  abdomen,  observe  the  stomach 
and  intestines,  the  liver  and  bladder.  Also  notice  the  brain 
and  spinal  marrow. 

The  Autopsy.  —  The  first  incision  should  be  made  com- 
mencing at  the  center  of  the  lower  jaw,  and  extending 
to  the  lower  end  of  the  sternum.  Some  advise  to  divide 
the  lower  jaw  at  the  symphysis,  so  as  the  more  completely 
to  expose  the  buccal  cavity,  in  the  search  for  foreign  sub- 
stances ;  this,  however,  may  not  be  necessaiy.  The  posi- 
tion and  appearance  of  the  tongue  are  to  be  especially 
noticed.  The  larynx  and  trachea  are  next  to  be  laid  open, 
and  as  much  of  the  esophagus  as  can  now  be  seen.  The 
incision  is  now  to  be  carried  down  on  each  side  of  the  spine 
of  the  ilia,  and  the  triangular  portion  of  the  integuments 
thus  shaped  out  is  to  be  turned  back,  so  as  to  examine  the 
condition  of  the  umbilical  vessels.  The  abdomen  is  next 
to  be  opened,  and  the  position  of  the  diaphragm  noticed. 


268  MEDICAL   JURISPRUDENCE. 

All  the  viscera  are  to  be  carefully  inspected,  together  with 
the  ductus  venosus,  behind  the  liver.  The  stomach  and 
bowels  are  to  be  tried  and  removed  in  order  to  search  for 
poison,  if  suspected.  The  gall-bladder  and  urinary  bladder 
should  be  examined,  also  the  presence  or  absence  of  me- 
conium in  the  large  intestines  be  ascertained. 

The  thorax  should  be  opened  with  the  scissors,  preferably 
to  the  knife,  at  the  junction  of  the  costal  cartilages.  After 
-examining  the  general  appearance  of  the  contents,  all  the 
great  vessels  are  to  be  tied,  and  divided  beyond  the  liga- 
tures ;  the  trachea  is  also  to  be  divided  at  its  root.  The 
lungs  are  then  to  be  taken  out  and  weighed,  and  subjected 
to  the  hydrostatic  test.  The  heart  may  now  be  examined 
as  to  the  condition  of  the  foramen  ovale  and  ductus  arterio- 
sus. The  head  may  be  examined  by  making  one  incision 
from  the  root  of  the  nose  back  to  the  neck,  and  another 
at  right  angles  from  ear  to  ear ;  strong  scissors  should  be 
used  in  cutting  through  the  bones.  The  brain  is  to  be 
removed  and  inspected  in  the  usual  manner.  The  spinal 
cord  will  often  require  examination ;  and  sometimes  also  the 
vertebrae. 

The  other  two  questions  pertaining  to  the  infant,  in  a 
case  of  child-murder,  have  reference  to  its  age  and  the 
interval  elapsed  since  its  death.  The  age  of  the  new-born 
child  is  to  be  determined  by  ascertaining  if  it  exhibited  the 
recognized  character  of  a  fully  matured  fetus.  The  exact 
interval  of  time  that  has  elapsed  since  its  death  cannot  be 
determined  merely  by  a  medical  inspection.  Many  circum- 
stances would  have  to  be  considered,  such  as  the  season 
of  the  year,  the  temperature,  the  place  where  the  body  was 
discovered,  etc.,  before  the  examiner  could  venture  an 
opinion ;    and  he  should  always  be  extremely  cautious  in 


INFANTICIDE.  269 

the  matter,  seeing  how  uncertain  are  the  signs  on  which 
that  opinion  is  to  be  founded. 

It  is  necessary  in  every  case  of  alleged  infanticide  to  con- 
nect the  condition  of  the  reputed  mother  with  that  of  the 
infant,  so  as  to  establish  the  fact  that  she  has  been  actually 
delivered  about  the  time  when  it  is  judged  that  the  child 
was  born.  This  is  easy,  in  a  recent  case,  if  the  mother  is 
willing  to  submit  to  medical  examination,  but  it  is  altogether 
different  when  a  considerable  interval  has  elapsed  since  the 
birth. 

The  question,  then,  is,  Has  the  woman  under  examina- 
tion been  recently  delivered  ?  If  the  examination  is  made 
within  three  or  four  days  after  deliveiy,  the  following  signs 
will  usually  be  exhibited :  there  is  more  or  less  weakness, 
some  pallor  of  face ;  the  eyes  a  little  sunken,  with  a  dark 
areola  under  or  around  them  ;  the  skin  is  soft,  moist,  and 
relaxed  ;  the  whole  aspect  resembling  that  of  a  person 
recovering  from  sickness.  The  pulse  is  soft  and  a  little 
quickened ;  the  abdomen  feels  soft  and  relaxed  to  the 
touch,  and  is  sometimes  thrown  into  folds,  and  presents,  on 
the  surface,  a  number  of  transverse,  Hvid  lines,  which,  at  a 
later  period,  become  white  and  shining,  or  silvery  {linecB 
albicantes).  The  uterus  can  be  distinctly  felt  through  the 
wall  of  the  abdomen,  low  down,  like  a  large  ball.  The 
breasts  have  a  full  and  somewhat  knotted  feel  ;  they  are 
generally  enlarged,  and  the  nipples  are  prominent  and  often 
exude  a  watery  milk. 

The  external  organs  of  generation  are  swollen,  relaxed 
and  moist ;  the  vagina  capacious,  and  without  folds  ;  the  os 
titeri  easily  felt  to  be  low,  and  somewhat  patulous  ;  the  lips 
soft  and  relaxed,  and  perhaps,  slightly  lacerated.  The 
uterine  sound  will  show  the  increased  depth  of  the  uterine    , 


2/0  MEDICAL    JURISPRUDENCE. 

cavity,  and  prove  the  tumor  felt  from  the  outside  to  be  the 
womb.  There  will  be  a  dark,  muco-sanguinolent  discharge 
from  the  uterus,  known  as  the  lochia,  readily  distinguish- 
able by  its  peculiar  odor.  The  color  of  the  lochia  subse- 
quently becomes  much  Hghter,  or  greenish  ;  this  discharge 
usually  disappears  in  a  week  or  ten  days,  and  in  some 
instances  it  is  suppressed. 

These  signs  combined  form  very  satisfactory  proof  of 
delivery,  although  none  of  them  can  be  relied  upon  singly. 
The  condition  of  the  genital  organs  affords  the  most  con- 
clusive evidence. 

The  linecB  albicantes  may  result  from  any  distention  of  the 
abdomen,  as  ascites,  uterine  tumor,  etc.  ;  they  have  even 
been  seen  in  the  male.  The  secretion  of  milk  may  be 
absent,  and,  again,  it  may  occur  in  the  unimpregnated  con- 
dition ;  but  the  presence  of  colostrum  among  the  milk 
corpuscles  (to  be  determined  by  the  microscope)  may  be 
regarded  as  conclusive  evidence  of  a  recent  delivery.  The 
lochia  and  the  relaxed  state  of  the  genital  organs  might  be 
mistaken  for  the  catamenia,  except  for  the  peculiar  odor  ; 
but  the  jagged  or  notched  condition  of  the  os  ziferi  and  its 
patulous  state  are  usually  to  be  attributed  to  a  recent 
delivery. 

All  the  above  signs  of  delivery  fail  completely  after  the 
lapse  of  five  to  ten  days,  except  the  still  increased  size  of  the 
uterus,  and  its  rather  open  and  jagged  mouth,  together  with 
the  silvery  lines  across  the  abdomen.  The  two  last  men- 
tioned signs  would  be  positive  evidence,  provided  this  could 
be  shown  to  have  been  the  woman's  first  pregnancy,  and 
provided,  also,  the  absence  of  any  other  abdominal  swelling 
could  be  proved.  Otherwise,  they  only  afford  grounds  for 
suspecting  one  or  more  former  deliveries. 


INFANTICIDE.  2/1 

Signs  of  Delivery  in  the  Dead.  —  Supposing  the  woman  to 
have  died  immediately  after  her  delivery,  the  evidences  of 
that  fact  will  be  sufficiently  manifest.  Besides  the  condi- 
tion of  the  external  organs  above  described  in  the  case  of 
the  living,  on  opening  the  abdomen  the  uterus  will  be 
found  flat  and  flaccid,  between  nine  and  twelve  inches  long, 
and  with  the  os  wide  open.  The  cavity  will  contain  bloody 
coagula,  with  the  remains  of  the  decidua  lining  the  inner 
surface.  The  attachment  of  the  placenta  will  be  marked  by 
a  gangrenous-looking  spot.  If  the  death  has  been  delayed 
only  a  few  days,  the  womb  will  be  considerably  modified  ; 
and  if  three  or  four  weeks  have  elapsed,  it  will  be  as  difficult 
to  determine  delivery  in  the  dead  as  in  the  living. 

The  fact  of  unconscious  delivery  must  be  admitted,  as  it 
is  supported  by  positive  evidence,  and  as  it  is  in  accord 
with  the  well-known  instances  of  a  similiar  character  in 
women  when  in  coma,  epilepsy,  asphyxia,  narcotism,  and 
anesthesia  from  ether  and  chloroform,  and  also  when  in  a 
profound  natural  sleep. 

Concealed  Delivery.  —  In  nearly  every  case  of  infanticide, 
it  is  the  object  of  the  woman  both  to  conceal  the  body  of  her 
child  and  hide  all  traces  of  her  delivery.  The  concealment 
of  pregnancy  is  no  offence  in  law,  but  the  concealment  of 
delivery  or  of  the  birth  of  a  child  is  a  misdemeanor.  As  a 
matter  of  fact  and  practice,  however,  women  who  are  tried 
on  this  charge  are  punished,  not  for  concealment  of  the 
birth,  but  for  concealment  of  the  body  of  the  child — a  dis- 
tinction which  excites  hope  in  the  criminal  that  if  she  can 
do  away  with  the  body  she  may  be  free  of  the  law.  Ac- 
cording to  statute,  the  child  must  be  dead  ;  the  concealment 
of  a  Hving  body  is  no  offense,  unless  it  should  happen  to 


2/2  MEDICAL    JURISPRUDENCE. 

die  before  the  birth  was  made  known.  In  a  trial  for  con- 
cealment of  birth,  the  medical  evidence  is  derived  exclusively 
from  the  mother  ;  the  body  of  the  child  need  not  be  pro- 
duced, and  the  special  points  which  will  engage  attention 
are  (i)  the  proofs  of  recent  delivery;  (2)  the  proofs  of  pre- 
vious pregnancy,  and  (3)  the  connection  between  the  alleged 
period  of  delivery  and  the  state  of  the  child  as  found. 

Pretended  Delivery. — This  occasionally  occurs  for  various 
motives,  and  sometimes  without  any  assignable  motive.  A 
medical  examination  will  detect  the  imposture,  because  the 
assumed  delivery  must  be  recent  and  not  remote.  The 
pretense  may  occur  when  the  woman  has  never  been  preg- 
nant, when  she  had  been  pregnant,  and  when  she  had  been 
delivered,  but  had  substituted  a  Hving  for  a  dead  child. 

Evidences  of  the  Death  of  the  Child  before  its  Birth.  —  The 
question  whether  the  child  is  dead  in  ittero  may  require  to 
be  determined  in  certain  civil  cases  involving  succession  to 
an  estate,  contingent  to  the  life  of  the  child  ;  also  in  criminal 
cases  —  as  where  a  pregnant  woman  has  been  maltreated, 
and  her  unborn  offspring  is  alleged  to  be  dead.  During 
pregnancy,  the  life  of  the  fetus  is  inferred  from  the  general 
good  health  of  the  mother,  although  this  is  by  no  means  a 
positive  sign.  The  progressive  increase  in  the  size  of  the 
abdomen,  together  with  the  continuance  of  the  fetal  move- 
ments, though  strongly  suggestive  of  fetal  life,  are  not 
absolute  proofs.  The  only  unequivocal  sign  is  the  sound 
of  the  fetal  heart  repeatedly  heard  by  auscultation. 

The  indications  of  the  death  of  the  fetus  during  preg- 
nancy are  the  cessation  of  all  motion,  after  this  has  been 
positively  felt  by  the  woman.  She  experiences  a  sensation 
of  a  dead  weight  in  the  abdomen,  along  with  a  sense  of 


INFANTICIDE.  2^3 

lassitude  ;  the  breasts  are  apt  to  recede,  or  become  less 
prominent  ;  there  is  pallor  of  the  countenance,  with  a  dark 
circle  around  the  eyes  ;  the  spirits  flag,  amounting  at  times 
to  melancholy  ;  the  breath  is  fetid.  While  these  signs 
combined  may  excite  a  strong  suspicion  of  the  death  of  the 
embryo,  the  only  positive  and  unequivocal  proof  of  it  would 
be  the  ascertained  continuous  absence  of  the  beat  of  the 
fetal  heart  by  means  of  the  stethoscope.  It  is  stated,  on 
good  authorities,  that  the  placental  murmur  may  continue 
some  time  after  the  death  of  the  fetus. 

During  delivery  the  signs  of  the  child's  Hfe  are  limpidity 
of  the  waters,  regularity  of  the  pains,  with  increase  in 
strength,  pulsation  of  the  cord,  heart,  and  fontanelles. 

Putrefaction  of  the  fetus  generally  occurs  soon  after  its 
death  in  uiero,  and  it  is  usually  prematurely  expelled  within  . 
a  few  weeks  ;  but  occasionally  it  is  retained  until  the  full 
term,  and  may  even  then  not  exhibit  the  marks  of  decom- 
position. The  various  causes  that  may  occasion  the  intra- 
uterine death  of  the  child  have  already  been  described. 

The  indications  of  the  child's  death  during  delivery  are 
fetid  discharges  instead  of  limpid  waters,  absence  of  all 
motion,  a  livid  appearance  of  the  skin,  no  pulsation  of  the 
umbilical  cord,  the  cuticle  peeling  off  the  head  in  flakes, 
and  the  bones  of  the  cranium  loose  and  floating.  The 
lividity  of  the  skin  is  not  an  invariable  sign  ;  a  case  is  men- 
tioned in  which,  in  an  arm  presentation,  this  member  was 
so  livid  and  cold  as  to  be  supposed  certainly  to  indicate  the 
child's  death  ;  it  was  consequently  amputated,  in  order  to 
facilitate  the  labor,  but  to  the  discomfiture  of  the  obstet- 
rician, the  child  was  born  alive  and  survived. 

The  general  appearance  of  a  fetus  that  has  been  dead 
some  time  before  its  birth  has  already  been  described. 
23 


CHAPTER   XL 

LEGITIMACY— INHERITANCE. 

The  question  of  Legitimacy  is  one  involving  the  nearest 
and  dearest  interests  of  social  life,  and  one  at  times  sur- 
rounded with  no  slight  difficulties  arising  from  the  uncer- 
tainty of  most  of  the  evidence  usually  advanced. 

Cases  involving  the  question  of  legitimacy  are  rarely 
decided  upon  medical  evidence  alone ;  there  are  usually 
circumstances  which  indicate  the  parentage  of  the  child 
whose  legitimacy  is  disputed.  The  important  point  for  con- 
sideration of  the  physician  is  the  duration  of  gestation. 

The  following  positions  may  be  considered  as  settled  by 
the  laws  of  this  country  and  England :  — 

I.  Every  child  born  in  wedlock  is  presumed  to  be  legiti- 
mate, unless  it  can  be  shown  (i)  that  the  parties  had  been 
separated  for  a  time  beyond  the  period  of  gestation  ;  (2)  that 
the  husband  was  impotent ;  (3)  adultery  on  the  part  of  the 
wife  and  the  repudiation  of  the  alleged  child  by  the  hus- 
■■band.  When  the  woman  was  so  far  advanced  in  pregnancy 
at  the  time  of  her  marriage  that  her  situation  must  have 
been  known  to  her  husband,  this  will  be  deemed  as  a 
recognition  of  paternity,  and  also  of  legitimacy,  on  his 
part. 

A  child  born  after  the  death  of  its  father  or  mother  (as 
by  the  Caesarean  section)  is  held  to  be  legitimate,  although, 
strictly  speaking,  the  marriage  tie  is  dissolved  by  death ; 
hence,  as  remarked  by  Taylor,  a   child   may  be   conceived 

274 


LEGITIMACY.  2/5 

before  marriage,  and  born  after  the  death  of  the  mother  or 
father,  and  yet  be  legitimate,  although  neither  conceived 
nor  born  in  wedlock. 

Duration  of  Gestation. — The  usual  popular  notion  upon 
this  point  is  that  it  comprises  nine  calendar  months  (273  to 
275  days),  or  ten  lunar  months  (280  days).  Ten  lunar 
months  was  the  period  allotted  by  the  Roman  law,  which 
was  also  the  opinion  of  Harvey,  dating  from  the  commence- 
ment of  the  last  menstrual  period.  There  seems  to  be  a 
fair  physiological  presumption  for  this  latter  view,  based  on 
the  idea  that  parturition  occurs  at  the  period  of  what  would 
be  the  tenth  menstrual  effort  since  the  last. 

The  discordance  existing  on  this  subject  arises  partly 
from  want  of  a  definite  starting-point.  This  is  usually  fixed 
by  the  woman  by  certain  peculiar  sensations  supposed  to  be 
experienced  at  conception  or  at  the  period  of  quickening. 
The  first  is  altogether  fallacious,  for  conception  may  occur 
in  the  unconscious  state.  The  second  is  equally  uncertain, 
since  the  time  of  quickening  varies  so  much  in  different 
women, — from  the  twelfth  to  the  twenty-fifth  week  ;  and  in 
some  it  is  not  perceptive  at  all,  whilst  in  others  it  may 
be  supposed  to  exist  even  in  the  absence  of  pregnancy. 
The  cessation  of  catamenia  is  the  usual  and  the  surest 
method  of  calculating,  but  it  is  liable  to  many  fallacies, 
such  as  the  arrest  of  the  menses  before  pregnancy;  their 
continuance  for  a  month  or  more  after  pregnancy,  and  the 
intervals  between  the  periods  not  being  the  same  in  all 
women.  Usually  there  is  an  interval  of  twenty-eight  days 
from  the  commencement  of  one  period  to  the  commence- 
ment of  another,  but  it  is  frequently  longer  or  shorter,  and 
this  in  the  same  woman  at  different  times.     As  conception 


2/6  MEDICAL    JURISPRUDENCE. 

may  take  place  at  any  period  of  the  interval  between  the 
catamenia,  it  is  evident  there  might  be  a  difference  of  twenty- 
three  to  twenty-five  days  as  to  its  actual  date,  according  as 
it  occurred  immediately  after  the  one  catamenial,  or  imme- 
diately before  the  succeeding  period.  The  usual  custom 
among  married  women  is  to  reckon  nine  calendar  months 
from  the  last-mentioned  period,  and  to  add  about  fourteen 
days  for  possible  error.  There  is  a  diversity  of  opinion 
among  obstetricians  of  the  highest  reputation  on  the  subject 
of  the  natural  period  of  gestation — varying  from  274  to  301 
days.  It  may  be  assumed  that  the  average  period  is  between 
thirty-eight  and  forty  weeks. 

The  most  certain  and  positive  starting-point  from  which 
to  fix  the  date  of  conception  is  a  single  intercourse.  Even 
where  this  can  be  accurately  settled,  still  there  will  be  found 
considerable  discrepancies  which  must  be  attributed  to  in- 
dividual peculiarities,  and  which  indicate  that  there  is  no 
absolute  law  on  the  subject.  Observation  shows  periods 
varying  from  233,  249,  and  260  days,  up  to  293  and  313 
days.  Even  rejecting  the  two  extreme  cases  of  233  and  313 
days  (though  they  are  perfectly  authenticated),  as  very 
exceptional,  we  still  have  the  great  variation  of  forty -four 
days  between  the  two  extremes  of  249  and  293  days,  or  of 
sixty  days  between  the  extremes  of  233  and  293  days. 
Taking  the  average  of  fifty-six  cases,  dating  from  a  single 
coitus,  reported  by  various  authors,  ranging  between  260 
and  296  days,  it  will  be  found  to  be  276  days. 

The  irregularity  as  regards  the  normal  period  of  gesta- 
tion in  the  human  female  finds  its  analogy  among  the  lower 
animals.  Extended  observations  made  upon  the  cow,  the 
mare,  and  the  sheep  confirm  the  results  observed  in  the 
human  female.     In  the  cow  the  average  period  of  gestation 


LEGITIMACY.  2^7 

is  about  285  days;  yet,  from  Dr.  Krahmer's  tables,  it  is 
found  that,  out  of  1,105  cows,  335  calved  on  the  fortieth 
week,  429  on  the  forty-first  week,  and  135  on  the  forty- 
second  week  ;  the  balance  varied  from  the  thirty-eighth 
week  to  the  fifty-first  week  —  a  period  of  about  90  days. 

In  sheep,  the  average  time  among  177  births  examined 
was  150  days  ;  yet  the  period  varied  from  145  to  171  days 
—  a  difference  of  26  days. 

In  mares,  whose  normal  term  of  gestation  is  about  300 
days,  Tessier  found,  out  of  102,  that  21  went  as  far  as  360 
days  and  one  as  far  as  394  days. 

The  logical  conclusion  from  the  above  statements  must 
be  that  it  is  possible  for  human  pregnancy  to  be  prolonged 
beyond  the  usually  admitted  normal  period  ;  but  the  ques- 
tion how  far  beyond  is  rather  difficult  to  answer ;  though 
the  greater  the  amount  of  deviation,  the  stronger  and  more 
convincing  should  be  the  proofs. 

It  is  an  error  to  suppose  that  a  protracted  pregnancy  is 
accompanied  by  an  increased  size  of  the  child,  although, 
physiologically  considered,  the  fetus  ought  to  continue  to 
increase  in  size  in  tttei'o  after  the  usual  term  of  gestation. 

The  celebrated  Gardner  Peerage  Case  well  illustrates 
many  of  the  above  points.  Lord  and  Lady  Gardner  parted 
from  each  other  on  January  30th,  1802.  The  husband 
returned  on  July  nth  of  the  same  year.  During  his 
absence,  his  wife  was  known  to  be  living  in  adulterous 
intercourse  with  a  Mr.  Jadis.  She  was  deUvered  of  a  son 
on  the  8th  of  December,  three  hundred  and  twelve  days 
after  Lord  Gardner's  first  absence  and  one  hundred  and 
fifty  days  (about  five  months)  after  his  return.  The  child 
was  perfectly  developed  and   mature   at  its  birth,  so  that 


278  MEDICAL    JURISPRUDENCE. 

the  idea  of  a  premature  birth  was  not  entertained,  and  the 
only  question  was  as  to  the  possibility  of  a  protracted  ges- 
tation. The  ablest  obstetrical  experts  were  engaged  on 
both  sides  at  the  trial,  and,  as  usual,  there  was  a  difference 
of  professional  opinion  upon  the  subject,  some  maintaining 
that  the  period  of  gestation  was  absolutely  fixed,  while 
others  (the  majority)  admitted  the  possibility  of  its  being 
protracted.  The  case  was  decided  against  the  claimant 
(the  alleged  son),  not,  however,  on  the  ground  of  the  pro- 
tracted period  of  his  birth,  but  on  the  ground  of  his  mother's 
notorious  adultery  and  her  concealment  of  his  birth. 

A  circumstance  often  lost  sight  of  in  this  discussion  is 
that  conception  is  not  always  synchronous  with  intercourse 
or  insemination.  The  former  occurs  only  when  the  sper- 
matozoids  come  in  actual  contact  with  the  ovum.  This 
may  take  place  in  the  uterus  or  in  the  Fallopian  tube,  and 
sevfcral  days  may  elapse  after  intercourse  before  it  is  actu- 
ally accomplished.  The  spermatozoids  are  known  to  retain 
their  vitality  for  a  period  of  several  days  within  the  vagina  ; 
and  as  fecundation  cannot  result  until  these  meet  the  ma- 
tured ovum  (which  requires  a  variable  period  for  its  descent 
from  the  ovary),  conception  might  be  delayed  as  long  as 
seven  days.  This  does  not  explain  the  lengthened  varia- 
tions of  gestation  above  noted.  As  Taylor  remarks  :  "We 
must  be  prepared  to  admit  either  that  conception  may,  in 
some  cases,  be  delayed  for  so  long  a  period  as  five  to  seven 
weeks  after  intercourse,  or  that  there  may  be  a  difference  of 
from  five  to  seven  weeks  in  the  duration  of  pregnancy." 
Winckel  states  that  a  pregnancy  may  vary  from  240  to  320 
days  and  even  exceed  the  latter  limit.  Nearly  seven  per 
cent,  of  the  cases  are  over  300  days. 


LEGITIMACY;  2/9 

II,  Premature  Birth.  —  Diminished  Period  of  Gestation.  — 
Early  Viability. — An  important  question  in  connection  with 
legitimacy  is,  whether  a  child,  in  all  points  fully  developed, 
can  be  born  before  the  ordinary  period  of  gestation  ?  Its 
bearing  upon  the  subject  of  legitimacy  is  direct  and  im- 
portant. For  instance,  a  husband,  after  a  long  absence, 
returns  to  his  wife,  and  a  fully  developed  child  is  born  after 
seven  or  eight  months.  Is  this  a  legitimate  child  ?  The 
question  is  about  as  difficult  to  determine  as  the  former  one 
concerning  a  protracted  pregnancy.  It  must  be  admitted 
that  children  at  full  term  differ  extremely  in  size,  weight, 
and  in  apparent  maturity,  so  that  some  eight  months'  chil- 
dren may  appear  better  developed  than  some  at  nine  months. 
This,  however,  is  the  exception  and  not  the  rule.  Again, 
it  is  known  that  some  women  always  give  birth  to  their 
children  before  the  full  term  ;  but  these  may  be  regarded 
as  cases  of  diseased  action.  The  probabilities  are  strongly 
against  it. 

Again,  since  in  cases  of  prolonged  gestation  the  children 
do  not  continue  to  grow  in  utero  after  their  full  period,  it 
would  seem  still  less  probable  that,  in  the  earlier  months  of 
fetal  existence,  they  should  be  one,  two,  or  three  months 
in  advance  of  their  normal  intra-uterine  life.  Dr.  Mont- 
gomery states  that  he  never  saw  a  seven  months'  fetus  pre- 
sent the  remotest  appearance  of  the  fully  matured  child. 

It  seems,  therefore,  that  while  in  some  instances  there 
may  be  a  doubt  about  an  eight  months'  child,  on  account 
of  its  advanced  degree  of  development,  there  ought  to  be 
no  doubt  whatever  in  the  case  of  a  six  or  seven  months' 
child.  The  peculiar  characters  presented  by  the  fetus  at 
these  ages  have  been  given. 

In  an  English  case,  in  which  the  question  of  the  legiti- 


280  MEDICAL  JURISPRUDENCE. 

macy  of  a  child  was  made  to  depend  upon  the  period  of  the 
mother's  gestation — 259  days  or  37  weeks  (or  three  weeks 
lacking  maturity) — Simpson  gave  evidence  that  a  child  born, 
perfectly  matured,  three  weeks  before  the  usual  term,  could 
not  be  legitimate.  This  is  certainly  stronger  ground  than 
many  would  take.  To  stamp  a  child  as  a  bastard,  and  to 
impute  the  crime  of  adultery  to  the  mother,  because  of  the 
three  weeks'  prematureness  of  the  birth,  even  though  ap- 
parently mature,  is  an  assumption  not  warranted  by  num- 
erous facts. 

As  regards  the  earliest  viability  of  a  child,  or  the  earliest 

period  of  intra-uterine  life  at  which  it  is  capable  of  living, 

]  there  is  a  universal  admission  that  an  eight  or  even  a  seven 

I^    ^  months'  child  may  survive ;  that  occasional  instances  have 

'  occurred  where  a  six  months'  infant  Hved  ;  and  that  a  very 

^  few  exceptional  cases  have  been  recorded  of  the  survival  of 

I  children  born  a  little  over  five  months.     An  infant  born 

earlier  than  this  period  could  not  be  considered  viable. 

The  question  of  premature  birth  may  present  itself  under 
a  civil  aspect,  that  of  survivorship,  when  a  living  child 
acquires  civil  rights — such  as  inheritance  and  the  transmis- 
sion of  property.  In  such  a  case  it  becomes  a  matter  of 
vital  importance  to  establish  the  fact  that  the  child,  when 
born,  was  actually  alive.  The  laws  of  this  country  and  of 
England  do  not  require  that  the  child  should  be  viable,  i.  e., 
capable  of  continuing  to  live,  but  only  that  it  should  be 
born  alive.  It  matters  not  whether  it  be  mature  or  imma- 
ture, so  that  it  was  alive. 

What,  then,  constitutes  a  Hve  birth  ?  Anything  that  will 
prove  that  the  child  was  living  at  the  time  of  its  birth. 
According  to  the  laws  of  the  United  States  and  England, 
neither  breathing  nor  crying  are  essential  to  establish  a  live 


LEGITIMACY.  251 

birth  ;  the  pulsation  of  the  child's  heart,  or  of  one  of  its 
arteries,  or  the  sHghtest  voluntary  movement,  is  regarded 
as  sufficient  for  this  purpose.  In  Scotland,  crying  is  re- 
garded as  essential ;  in  France,  respiration  ;  and  in  Germany, 
crying,  "attested  by  unimpeachable  witnesses."  According 
to  Blackstone,  crying,  indeed,  is  the  strongest  evidence,  but 
it  is  not  the  only  evidence  ;  and  Coke  remarks  —  "  If  it  be 
born  alive,  it  is  sufficient,  though  it  be  not  heard  to  cry,  for 
peradventure  it  may  be  born  dumb." 

With  this  clear  and  definite  understanding  of  what  is 
legally  regarded  as  the  proofs  of  a  live  birth,  we  must 
admit  that  fetuses  have  been  born  alive  as  early  as  four 
months,  and,  of  course,  at  all  periods  of  a  later  date.  Such 
a  case  is  reported  by  Dr.  Erbkam,  of  Berlin,  in  which  the 
fetus  was  only  six  inches  long  and  weighed  but  eight 
ounces  ;  it  survived  half  an  hour ;  it  moved  its  legs  and 
arms,  turned  its  head  from  side  to  side,  and  opened  its 
mouth.  Miiller  pronounced  this  fetus  to  be  not  over  four 
months  old.  Dr.  Barrows,  of  Hartford,  reports  another 
case,  especially  interesting  from  the  fact  that  the  exact 
period  of  conception  could  be  fixed  ;  miscarriage  took  place 
at  144  days  —  less  than  five  calendar  months.  The  ovum 
was  expelled  entire.  Before  rupture  of  the  membranes,  the 
movements  of  the  child  were  vigorous.  After  the  rupture 
it  cried  out  very  distinctly ;  the  cord  was  tied  on  ceasing  to 
pulsate,  after  which  it  breathed  with  a  gasp  for  forty 
minutes  ;  it  repeatedly  opened  its  mouth  and  thrust  out  its 
tongue.  It  measured  ten  inches  long  and  weighed  four- 
teen ounces. 

Tenancy  by  Courtesy. — This  phrase  signifies,  accord- 
ing to  Blackstone,  "  a  tenant  by  the  courts  of  England," 
24 


282  MEDICAL   JURISPRUDENCE. 

and  is  applied  to  the  case  in  which  a  husband  acquires  a 
life -interest  in  the  property  of  his  wife  at  her  death,  pro- 
vided a  child  was  born  of  the  marriage,  living,  during  the 
wife's  life,  "In  this  case"  (in  the  old  law  language)  "he 
shall,  on  the  death  of  his  wife,  hold  the  lands  for  his  life, 
as  tenant  by  the  courtesy  of  England."  If  there  should 
be  no  living  issue,  the  property  would  pass  to  the  heir-at- 
law.  In  every  such  case  the  following  conditions  must  be 
settled:  (i)  There  must  be  proof  of  a  live  birth.  We 
have  already  adverted  to  the  proofs  required  to  establish  a 
live  birth  in  different  countries.  (2)  The  child  must  be 
born  while  the  mother  is  living.  This  was  the  old  dictum 
of  Lord  Coke  some  three  hundred  years  ago.  Hence,  if 
a  living  child  were  extracted  by  the  Caesarean  section  from 
a  dead  mother,  it  could  not  transmit  an  inheritance.  It  is 
not  certain  that  this  doctrine  would  be  followed  by  modern 
courts.  (3)  The  child  must  be  born  capable  of  inheriting ; 
therefore,  a  monster  cannot  inherit  or  transmit  a  property. 
It  is  difficult  to  give  a  legal  definition  of  a  monster. 
Clearly,  no  mere  external  deformity  or  internal  malforma- 
tion would  constitute  such  a  disability.  Lord  Coke  defines 
a  monster  as  "  a  being  that  hath  not  the  shape  of  mankind." 
Thus,  an  acephalous,  dicephalous,  or  disomatous  creature 
would  seem  to  be  excluded.  St.  Hilaire's  distinction  in 
relation  to  such  beings  is  usually  followed,  viz.,  to  consider 
every  monster  with  two  equally-developed  heads,  whether 
disomatous  or  not,  as  two  distinct  beings  ;  and  every  mon- 
ster with  a  single  head,  disomatous  or  not,  as  only  one 
being.  It  is  difficult  to  say  how  such  a  ruling  would  apply 
as  to  the  exclusion  of  the  Siamese  twins  and  other  similar 
cases.  In  several  of  our  own  States,  the  old  English  law 
of  the  "  Tenancy  by  Courtesy  "    still  prevails.     Dr.  Reese 


LEGITIMACY.  283 

was  once  called  as  an  expert,  in  the  State  of  Delaware,  to 
determine  the  fact  of  the  live  birth  of  a  child  which  had 
neither  breathed  nor  cried,  but  whose  heart  and  temporal 
arteries  had  pulsated  for  several  minutes  after  birth.  One 
of  the  parties  to  the  suit  adopted  the  usual  course  in  such 
cases,  namely,  to  assert  that  these  acts  of  the  circulation 
were  only  the  remnants  of  uterine  life,  and  could  not  be 
considered  as  evidences  of  an  independent  life  on  the  part 
of  the  infant ;  but  it  was  conclusively  shown  that  every 
action  of  a  person's  life  may,  in  one  sense,  be  regarded  as 
the  remnant  of  uterine  life,  and  that,  as  such  acts  could  not 
be  performed  by  a  dead  child,  the  only  alternative  was  to 
admit  that  it  was  alive.  Moreover,  several  cases  were 
cited,  both  English  and  American,  in  which  the  live  birth 
was  sustained  on  much  slighter  proofs  than  the  above. 

Laws  Concerning  Legitimacy.  —  The  Roman  law  did  not 
consider  a  child  legitimate  if  born  later  than  ten  calendar 
months  after  its  father's  death.  The  French  law  allows  the 
legitimacy  of  a  child  born  1 80  days  (or  six  calendar  months) 
after  marriage,  and  300  days  after  the  death  or  non-access 
of  the  husband.  The  Prussian  law  declares  a  child  legiti- 
mate that  is  born  within  302  days  after  the  husband's  death. 
In  Scotland,  the  legitimacy  of  a  child  is  established  if  it  is 
born  168  days  (six  lunar  months)  after  marriage,  and  within 
ten  months  after  the  death  of  the  husband.  In  the  Jadine 
case,  the  General  Assembly  of  the  Church  of  Scotland  pro- 
nounced in  favor  of  the  legitimacy  of  the  child,  which  was 
born  174  days  after  marriage. 

In  this  country  and  in  England  there  is  no  law  regulating 
the  exact  period  of  gestation  in  relation  to  legitimacy,  each 
case  being  decided  on  its  own  merits.     In  the  United  States, 


284  MEDICAL    JURISPRUDENCE. 

in  one  instance,  legitimacy  was  allowed  where  the  time  was 
317  days  ;  and  in  another  case,  affiliation  was  allowed  where 
the  period  was  3 1 3  days.  In  England  it  was  disallowed 
when  the  time  was  3 1 1  days  (Gardner  Peerage  Case)  ;  but, 
as  was  remarked  above,  the  moral  circumstances  of  this 
case,  rather  than  the  question  of  a  protracted  gestation, 
influenced  the  decision. 

Minority  and  Majority.  —  In  law  the  word  minor  or  in- 
fant signifies  a  person  under  the  age  of  twenty-one  years. 
Before  this  age,  he  or  she  is  regarded  as  incapable  of  per- 
forming certain  civil  acts,  such  as  serving  on  a  jury,  making 
a  will,  executing  a  deed,  or  other  contract.  The  law  has 
fixed  no  age  for  competency  as  a  witness,  the  court  judging, 
in  individual  cases,  of  the  mental  capacity  of  the  child.  It 
is  usually  held  that  a  child  up  to  seven  years  is  incapable 
of  distinguishing  right  from  wrong,  and  is,  therefore,  legally 
incapable  of  crime.  At  fourteen  a  child  is  considered  to 
have  arrived  at  years  of  discretion,  and  it  then  becomes 
responsible  for  its  actions,  as  for  murder  or  rape. 

A  person  attains  legal  majority  the  first  instant  of  the 
day  before  the  twenty-first  anniversary  of  his  or  her  birth- 
day, although  forty-seven  hours  and  fifty-nine  minutes  short 
of  the  complete  number  of  days,  counting  by  hours.  This 
is  on  the  principle  that  the  law  takes  no  account  of  part  of 
a  day.  Hence  the  importance  of  noting  the  exact  day  and 
hour  of  a  child's  birth,  as  a  few  minutes  or  hours  may  thus 
determine  the  attainment  of  majority. 

The  date  at  which  minority  ceases  is  subject  to  deter- 
mination by  statute,  and  hence  the  rule  may  vary  in  differ- 
ent States,  and  a  different  age  may  be  fixed  for  each  sex. 


LEGITIMACY.  285 

Paternity — Affiliation.  — The  question  oi Paternity  may 
present  itself  under  various  forms ;  as,  when  a  woman 
marries  a  month  or  so  after  the  death  of  her  first  hus- 
band, and  a  child  is  born  in  about  ten  months  afterwards ; 
also  when  a  supposititious  child  claims  to  be  heir  of  an 
estate  ;  and  still  more  frequently,  in  cases  of  bastardy,  when 
the  putative  father  is  obliged  to  support  the  child.  In  all 
such  cases  likeness  to  the  parent  is  regarded  as  strong  pre- 
sumptive proof  of  paternity,  requiring,  however,  further 
corroboration.  This  paternal  resemblance  extends  not  only 
to  the  features,  but  also  to  the  voice,  gesture,  attitude,  and 
habits. 

Paternal  likeness  may  obviously  be  shown  by  color,  as 
where  a  white  woman  gives  birth  to  a  mulatto  or  Mongo- 
lian child,  or  vice  versa. 

Personal  deformities  are  sometimes,  though  not  always, 
transmitted  from  parent  to  child  ;  but,  certainly,  it  would 
not  be  safe,  in  a  disputed  case  of  paternity,  to  make  the 
decision  solely  to  depend  on  this.  In  some  alleged  cases 
of  this  nature,  it  is  quite  possible  that  the  mind  of  the 
woman,  while  pregnant,  might  have  been  influenced  by  the 
mere  sight  of  the  deformed  man  alleged  to  be  the  father  of 
her  child. 

In  the  Douglass  Peerage  Case  this  question  of  paternity 
was  the  turning  point  as  to  whether  the  claimant,  Archi- 
bald, was  the  true  and  lawful  heir  to  the  title  and  estate. 
The  case  was  tried  in  1767,  in  the  Court  of  Session,  in 
Scotland,  and  lasted  eight  days.  Out  of  fifteen  judges, 
eight  decided  against  the  appellant.  The  case  was  then 
appealed  to  the  House  of  Lords,  which  reversed  the  former 
decision.  Lord  Mansfield  delivered  the  judgment,  and  took 
occasion  to  express  a  very  decided  opinion  in  favor  of  the 


286  MEDICAL   JURISPRUDENCE. 

parental  likeness  which  the  claimant  bore  to  his  father  as 
constituting  an  important  link  in  the  chain  of  evidence, 

A  case  of  affiliation  may  present  itself  in  which  a  child 
born  of  a  woman  who  has  had  intercourse  with  two  men 
within  a  few  days  of  each  other  is  affiliated  upon  one  of  the 
men  rather  than  upon  the  other.  Here  it  would  be  impos- 
sible to  settle  the  question  by  a  mere  medical  opinion. 
The  circumstances  of  color,  or  other  likeness,  or  some  acci- 
dent, might  assist  in  determining  the  question. 

Connected  with  the  question  of  paternity  there  is  a  curi- 
ous physiological  fact  that  might  occasionally  be  supposed 
to  affect  the  decision.  It  is  believed  by  breeders  of  horses 
and  cattle  that  the  influence  of  the  impregnation  by  one 
sire  may  be  extended  beyond  the  foal  begotten  at  the  time 
and  affect  those  begotten  subsequently  by  another  sire. 
This  is  proven  by  the  later  colts  or  calves  bearing  the 
peculiar  markings  of  the  first  sire.  The  question,  therefore, 
might  be  suggested  whether  this  same  handing  down  of 
parental  likeness  to  the  children  of  a  subsequent  father  might 
be  possible  ?  Without  any  positive  data  on  which  to  venture 
an  opinion,  it  may,  nevertheless,  be  suggested  here  as  a 
circumstance  to  be  considered  in  certain  cases  of  affiliation. 

Superfetation. — By  this  term  is  implied  the  conception 
of  a  second  embryo  in  a  woman  already  pregnant,  and  the 
birth  of  two  children  at  one  time  differing  considerably  in 
their  maturity,  or  of  two  births  at  different  times  of  mature 
children.  The  possibility  of  a  second  conception  after  a 
successful  impregnation  is  denied  by  some  authorities ;  but 
the  proof  of  it  is  abundantly  established  by  the  fact  of  a 
woman  giving  birth  to  two  children  of  different  colors,  and 
her  admitting  to  have  had  intercourse  with  a  white  and  a 


LEGITIMACY.  28/ 

black  man  successively.  It  must  also  be  accepted  as  pos- 
sible in  the  case  of  a  double  uterus.  The  usual  explanation 
given  by  those  who  reject  the  doctrine  is  that  there  was 
a  twin  conception,  and  that  one  of  the  embryos  became 
blighted  in  early  uterine  life  while  the  other  continued  to 
be  developed.  This  explanation  may  cover  some  cases  of 
alleged  superfetation,  but  certainly  not  all,  as  when  two 
perfectly  mature  children  are  born  three  or  four  months 
apart,  and  especially  when  two  children  of  different  color 
are  born  together,  or  one  soon  after  the  other. 

It  has  been  maintained  that  superfetation  is  impossible, 
because  of  the  physical  obstacle  to  the  entrance  of  the 
seminal  fluid  into  the  mouth  and  neck  of  the  uterus  caused 
by  conception.  This,  however,  has  been  denied  by  Dr. 
Duncan,  who  has  shown  that  the  mouth  of  the  womb  is  not 
immediately  closed  after  conception,  and  that  communica- 
tion between  the  vagina  and  ovary  is  not  cut  off  for  several 
months  after  impregnation,  and  that  there  is  no  impediment 
to  the  ascent  of  the  spermatozoids.  Others  attribute  the 
rarity  of  superfetation,  not  so  much  to  any  mechanical 
impediment,  as  to  the  absence  of  proper  ovules,  ovulation 
being  of  rare  occurrence  in  the  pregnant  condition. 

Double  conception  has  been  observed  in  the  lower 
animals,  as  in  a  mare  covered  successively  by  a  horse  and 
an  ass  :  she  produced  at  the  same  birth  a  horse  and  a  mule. 

The  result  of  all  the  observations  made  upon  this  subject 
is,  that  the  majority  of  the  alleged  cases  of  superfetation  '^ 
may  be  explained  (i)  upon  the  theory  of  twin  pregnancies, 
where  one  fetus  has  grown  at  the  expense  of  the  other, 
and  is  first  expelled,  the  other  remaining  until  it  has 
acquired  the  proper  maturity  ;  (2)  by  the  existence  of  a 
double  uterus.     Nevertheless,  there   are  a  few  other  cases 


288  MEDICAL   JURISPRUDENCE. 

which  do  not  admit  either  of  these  explanations,  and  which 
cannot  be  accounted  for  except  on  the  theory  of  two  suc- 
cessive conceptions. 

Doubtful  Sex  —  Hermaphroditism.  —  The  latter  term 
strictly  applies  to  those  cases  in  which  the  organs  of  both 
sexes  exist  in  the  same  individual ;  but  it  is  now  commonly 
employed  to  designate  all  cases  of  doubtful  sex.  With  the 
defective  sexual  development  there  are  usually  associated 
certain  peculiarities  which  indicate  the  preponderance  of 
the  characteristics  of  one  sex.  Until  the  period  of  puberty 
it  is  often  difificult  to  determine  the  particular  sex  of  the 
individual.  At  this  epoch,  however,  certain  changes  usually 
occur  that  show  the  preponderance  of  either  the  male  or 
female  sex^  such  as  change  of  voice,  greater  development 
of  the  shoulders  or  hips,  the  appearance  of  a  beard,  the 
development  of  the  breasts,  etc.  The  mere  absence  of 
testicles  does  not  prove  that  it  is  not  a  male,  since  the  testes 
sometimes  never  descend  into  the  scrotum.  Neither  does 
the  presence  of  a  beard  and  whiskers  necessarily  indicate 
that  it  is  not  a  female.  Women  have  been  seen  with  as 
flowing  a  beard  as  is  found  on  most  males.  In  some  cases 
an  external  examination  may  fail  to  indicate  the  sex  ;  the 
clitoris  may  be  mistaken  for  the  penis,  the  labia  for  the 
scrotum,  and  the  prostate  gland  for  the  uterus.  Even  a 
post-mortem  examination  may  not  always  succeed  in  clear- 
ing up  the  uncertainty. 

Important  medico-legal  relations  may  have  to  be  deter- 
mined in  cases  of  doubtful  sex.  Such  beings,  on  account 
of  imperfect  sexual  development,  may  be  impotent  and 
sterile,  hence  questions  of  divorce,  legitimacy  of  offspring, 
paternity,  and  affiliation  may  be  raised.    Such  beings  cannot 


LEGITIMACY.  289 

be  deprived  of  the  right  of  inheritance,  nor  in  the  United 
States  of  the  right  of  voting,  if  medical  testimony  shows 
a  preponderance  of  the  male  peculiarities.  In  case  of 
inheritance  depending  upon  the  sex  of  the  offspring,  when 
the  estate  and  title  descend  to  the  first-born  male,  if  the 
offspring  should  prove  to  be  of  doubtful  sex  the  prepond- 
erance of  the  male  peculiarities  would  have  to  be  clearly 
established  by  a  medical  examination  before  the  inheritance 
could  be  claimed. 

A  very  extraordinary  case  of  successful  concealment  of 
sex  is  that  of  Dr.  James  Bariy,  who  was  Staff  Assistant 
Surgeon  in  the  British  Army,  and  who  died  in  1865,  at 
eighty  years  of  age.  This  person  was  really  a  woman,  as 
was  proved  by  an  autopsy.  During  this  long  period  she 
had  managed  effectually  to  conceal  her  sex,  although 
effeminate  in  appearance  and  without  beard.  She  passed 
her  medical  examination  and  served  in  the  army  in  different 
quarters  of  the  globe,  and  exhibited  all  the  usual  qualities 
of  a  good  soldier  during  her  active  life. 

IMPOTENCE— STERILITY. 

Impotence,  or  the  want  of  procreative  power  in  the 
male,  may  be  functional  or  organic.  The  functional  causes 
include  debilitating  diseases,  masturbation,  opium  and 
alcohol  habits.  The  organic  causes  comprise  malformation 
of  the  genital  organs,  such  as  deficiency  of  the  penis,  fistula 
in  perineo,  castration  of  both  testicles,  cancer  or  other 
malignant  disease  of  the  testes,  and  malformation  of  the 
urethra,  as  hypospadias  and  epispadias.  Some  of  these 
defects  are  remediable,  while  others  are  not.  The  mere- 
absence  of  the  testes  from  the  scrotum  does  not  produce 


290  MEDICAL    JURISPRUDENCE. 

impotence,  for  such  persons  (crypsorchides)  are  capable  of 
begetting  children. 

In  professional  language,  the  term  impotence  is  applied 
to  the  male,  while  the  term  sterility  usually  refers  to  the 
same  condition  in  the  female,  including  both  a  physical 
sexual  incapacity  for  intercourse  and  also  unfruitfulness. 
A  distinction,  however,  should  be  made.  Strictly  speaking, 
the  male  may  be  sterile  without  being  impotent,  as  is  seen 
in  cases  after  castration  and  in  some  crypsorchides  ;  or  he 
may  be  impotent  without  being  sterile,  as  when  intercourse 
is  prevented  by  physical  malformation,  although  the  testes 
may  secrete  healthy  semen.  Again,  the  female  may  be 
unfruitful  without  being  incapable  of  intercourse,  or  vice 
versa.  As  regards  the  legal  disqualification  of  the  male  on 
the  ground  of  impotency,  all  that  is  necessary  to  prove  is 
simply  impotence  or  the  incapacity  for  intercourse.  In  the 
female,  incapacity  for  sexual  intercourse  (not  sterility)  can 
alone  be  adduced  as  a  ground  for  divorce. 

The  procreative  power  in  males  usually  commences  at 
puberty  with  the  full  development  of  the  sexual  organs, 
especially  the  testes.  The  exact  age  of  male  puberty 
varies,  but  it  may  be  stated  to  be  from  fourteen  to  seventeen 
years.  Until  this  period  is  attained  the  semen  does  not 
contain  spermatozoids,  on  which  alone  its  fecundating 
power  depends.  Doubtless,  certain  cases  of  sterility  are 
dependent  on  the  absence  of  these  from  the  seminal  fluid. 
It  would  also  appear  that  the  power  of  impregnation  is  de- 
pendent on  the  activity  of  movement  of  these  little  bodies. 
The  impotence  of  old  age  in  the  male  is  probably  owing  to 
the  feeble  motion  of  the  spermatozoids,  rather  than  to  their 
deficiency. 

The  procreative  power  in  the  male  may  continue  to  very 


LEGITIMACY.  29 1 

advanced  age,  if  conjoined  with  sound  bodily  health.  Sper- 
matozoids  have  been  found  in  the  semen  at  the  age  of 
eighty  years,  and  even  above.  Certain  diseases  impair  and 
destroy  this  power,  such  as  disorders  of  the  brain  and  spinal 
cord,  dropsy,  malignant  fevers ;  also  blows  on  the  head  and 
spine. 

Procreative  power  in  the  female.  —  The  term  sterility, 
when  applied  to  the  female,  is  usually  understood  to  mean 
an  inability  to  conceive.  This  power  is  manifested  at 
puberty,  or  when  the  function  of  menstruation  first  appears. 
The  precise  age  when  this  occurs  differs  in  different  coun- 
tries and  with  individual  females,  the  usual  earliest  periods 
being  twelve  and  thirteen  years  (some  exceptional  cases  as 
early  as  under  one  year  and  upward),  and  the  latest 
periods  nineteen  to  twenty-three  years.  Conception,  how- 
ever, may  take  place  in  women  who  have  never  men- 
struated ;  and  in  a  few  exceptional  instances  the  function 
never  occurred  throughout  life,  although  the  woman  may 
have  given  birth  to  several  healthy  children  and  enjoyed 
good  health  herself 

Instances  of  premature  puberty  are  not  uncommon. 
Cases  are  reported  where  girls,  one,  two  or  three  years 
old,  have  exhibited  the  physical  development  of  grown 
women,  and  in  whom  the  catamenia  appeared  at  this  early 
age  and  the  function  was  regularly  performed.  Menstrua- 
tion ceases,  in  the  majority  of  cases,  at  forty  to  fifty  years 
of  age,  but  there  are  many  exceptions.  As  it  may  com- 
mence early  so  it  may  terminate  late  —  even  up  to  sixty  or 
seventy  years,  and  in  some  remarkable  instances  even  to 
eighty  or  ninety  years. 

The  continuance  of  menstruation  is  usually  indicative  of 
the  power  of  conception.     Its   termination  nearly  always 


292  MEDICAL    JURISPRUDENCE. 

marks  the  cessation  of  the  woman's  abihty  to  bear  chil- 
dren. 

It  is  undeniable  that  women  have  conceived  after  the 
cessation  of  the  catamenia.  The  latest  age  for  pregnancy 
cannot  be  absolutely  fixed,  although  it  is  comparatively 
rare  after  forty-five  years,  and  almost  unknown  after  fifty- 
five  years. 

The  causes  of  sterility  in  the  female  are  various ;  some 
are  organic,  such  as  absence  of  the  uterus  or  the  ovaries, 
or  disease  of  these  organs  ;  imperforate  vagina  or  hymen  ; 
ovarian  and  uterine  tumors ;  occlusion  of  the  os  uteri  by 
constriction  ;  malposition  of  the  uterus,  etc.  Other  causes 
are  functional,  as  debility,  excessive  leucorrhea,  dysmenor- 
rhea, amenorrhea,  menorrhagia,  etc.  It  must  also  be  re- 
membered that  women  may  be  sterile  with  one  man  and 
fertile  with  another.  It  not  infrequently  happens  that  a 
woman  who  has  been  married  for  years  without  issue,  in 
contracting  a  second  marriage  may  have  several  children. 

Legal  Relations.  —  A  suit  for  divorce  may  be  procured 
by  either  party  on  the  ground  of  impotency,  provided  it 
can  be  shown  that  the  incapacity  existed  at  and  before 
marriage,  and  that  it  could  not  be  remedied.  There  should 
be  no  delay  in  bringing  the  suit,  and  there  should  be  proof 
that  the  incapacity  was  unknown  to  the  complaining  party 
at  the  time  of  the  contract.  If  the  alleged  cause  has  super- 
vened after  the  marriage,  there  can  then  be  no  grounds  for 
a  divorce.  To  sustain  this  charge  of  incapacity  a  medical 
examination  is  essential,  but  this  must  be  voluntary  on  the 
part  of  either  the  man  or  woman ;  the  courts  cannot  com- 
pel it.  A  mere  unwillingness  to  submit  to  sexual  inter- 
course on   the  part  of  a  wife,   or  what  the  law  terms  a 


LEGITIMACY.  293 

"frigidity  of  constitution,"  would  not  justify  a  legal  divorce. 
There  must  be  proof  of  sexual  incapacity  from  physical 
defect  in  either  party. 

Certain  cases  of  hysteria  and  vaginismus,  where  intol- 
erable pain,  and  even  spasm,  is  produced  in  the  woman  at 
eveiy  attempt  at  intercourse,  might  possibly  be  regarded  as 
affording  legal  grounds  for  a  divorce.  It  was  so  deter- 
mined in  one  case  of  hysteria  in  England ;  but  as  the  other 
affection  (vaginismus)  is  often  remediable,  it  is  doubtful  if 
the  courts  would  regard  this  as  a  sufficient  cause  for  grant- 
ing it. 


CHAPTER  XII. 

RAPE. 

Rape  is  legally  defined  to  be  the  "  carnal  knowledge  of 
a  woman  forcibly  and  against  her  will."  A  more  correct 
and  comprehensive  definition  would  be  "  carnal  knowledge 
without  her  conscious  permission,  or  with  such  permission 
extorted  by  physical  violence  or  fraud."  Physical  force, 
such  as  bodily  injuries  or  partial  strangulation,  is  not  re- 
quired by  the  law  in  order  to  constitute  this  crime  ;  the 
employment  of  narcotics,  anesthetics,  or  hypnotism,  or  the 
use  of  any  fraud  or  pretence  by  which  the  will  or  under- 
standing of  the  woman  is  influenced  or  overcome,  is  suffi- 
cient to  bring  the  act  within  the  limit  of  the  law. 

In  ancient  times  this  crime  was  variously  punished  by 
death,  castration,  fine,  and  imprisonment.  At  the  present 
day,  both  in  our  own  country  and  Great  Britain,  it  is  re- 
garded as  a  felony,  and  is  punished  by  imprisonment  or 
penal  servitude  for  a  term  of  years.  In  England,  until  the 
present  reign,  death  was  the  punishment  for  rape. 

As  this  crime  is  usually  committed  in  secret,  and  without 
witnesses,  the  law  receives  the  evidence  of  a  single  person 
(the  prosecutrix)  as  sufficient  to  estabhsh  the  charge.  As, 
however,  false  accusations  are  exceedingly  common,  med- 
ical evidence  is  generally  required  as  corroborative  proof. 
In  former  times  the  law  required  proofs  both  of  penetra- 
tion and  emission  on  the  part  of  the  male  ;  at  present  it  is 
only  requisite  to  adduce  proof  of  vulval  penetration,  even 
without  rupture  of  the  hymen. 

294 


RAPE.  295 

Rape  on  young  children  is  more  common  than  on  adult 
women,  and  for  this  several  reasons  are  assigned.  The 
most  obvious  one  is  the  comparative  facility  of  the  attempt, 
on  account  of  the  feebleness  of  resistance  and  the  ignor- 
ance of  children.  Another  reason  alleged,  particularly  in 
Europe,  is  a  superstition  prevailing  among  the  lower  orders 
that  an  obstinate  gonorrhea  is  most  certainly  cured  by 
having  intercourse  with  a  virgin  ;  and,  therefore,  a  young 
child  is  selected  for  this  purpose. 

Most  civilized  states  have  fixed  a  limit  of  age,  below 
which  the  act  of  intercourse  is  rape,  even  when  permitted 
by  the  child.  This  is  known  as  the  "  age  of  consent."  It 
is  not  uniform  in  all  countries ;  but  in  most  of  the  United 
States  a  female  under  ten  cannot  consent  to  sexual  inter- 
course. In  cases  of  the  idiotic,  or  feeble-minded,  or  insane, 
the  consent  of  the  female  is  usually  regarded  as  not  excus- 
ing the  criminality  of  the  act ;  but  each  case  must  be  de- 
cided according  to  the  circumstances,  such  as  the  degree  of 
mental  imbecility,  the  proof  of  consent,  and  the  employ- 
ment of  force  on  the  part  of  the  male. 

In  the  case  of  an  alleged  rape,  the  duty  of  the  physician 
summoned  is,  first  of  all,  to  make  a  note  of  the  exact  time 
and  date  of  his  examination,  since  this  may  hereafter  serve 
an  important  purpose  in  determining  if  the  prosecutrix  took 
the  earliest  opportunity  to  complain.  The  time  of  the 
alleged  offense  should  also  be  noted,  as  this  may  also  in- 
volve the  validity  of  an  alibi.  The  female  should  be  visited 
without  giving  her  time  for  preparation,  and  the  examina- 
tion at  once  be  made ;  but  it  should  be  remembered  that 
this  examination  cannot  be  made  without  her  full  consent, 
and  it  is  highly  advisable  that  such  consent  should  be  given 
in  presence  of  a  witness.    Examination  of  a  female  without  her 


296  MEDICAL    JURISPRUDENCE. 

consent  constitutes  an  indecent  assault  for  which  the  physi- 
cian may  be  punished.  It  is  probable  that  the  courts  would 
make  no  departure  from  this  principle  even  if  the  examining 
physician  were  a  woman.  Medical  evidence  is  derived  (i) 
from  marks  of  violence  about  the  genital  organs  ;  (2)  from 
bruises,  wounds,  or  other  marks  of  injury  on  the  person  of 
the  woman,  and  also  of  the  accused  as  denoting  resistance 
on  the  part  of  the  woman  ;  (3)  the  presence  of  spermatic 
and  blood  stains  on  the  person  or  clothing,  or  either,  or 
both  ;  (4)  the  existence  of  venereal  disease  on  one  or  both. 
Unless  the  examination  be  made  very  soon  after  the  act, 
all  traces  of  it  may  have  disappeared.  Three  or  four  days 
may  suffice  for  this ;  yet  in  many  cases  days  or  months 
elapse  before  an  examination  of  the  alleged  victim  is  insti- 
tuted, and  mistakes  consequently  often  result.  Casper 
states  that  in  fifty-eight  cases  he  examined,  the  time  that 
had  elapsed  from  the  alleged  commission  of  the  rape  varied 
from  three  weeks  to  one  year. 

Rape  on  Children. — The  fact  of  the  greater  frequency  of 
rape  upon  children  has  already  been  stated.  Out  of  1 1 1 
cases  examined  by  Casper,  the  ages  were  as  follows : 
seventy-eight  from  two  and  a  half  up  to  twelve  years  ;  seven- 
teen from  twelve  to  fourteen  years  ;  seven  from  fifteen  to 
eighteen  years ;  and  seven  from  nineteen  to  twenty-five 
years.  It  is  quite  probable  that  nearly  this  proportion 
would  be  found  to  exist  also  in  other  countries.  It  should 
not  be  forgotten  that  many  alleged  cases  of  rape  on  young 
children  are  entirely  fraudulent,  trumped  up  (often  by 
mothers)  chiefly  for  extorting  money.  All  the  authorities 
mention  numerous  instances  of  this  character,  Casper 
states  that  out  of  thirteen  cases  examined  he  found  nothing 


RAPE.  297 

whatever  to  support  the  accusation,  although  other  physi- 
cians had  pronounced  them  genuine,  and  some  of  them 
even  exhibiting  marks  of  chancre  !  In  all  genuine  cases 
the  genital  organs  should  exhibit  marks  of  injury,  if  the  act 
has  been  completed,  and  especially  if  any  resistance  was 
made,  such  as  laceration  of  the  pudendum,  the  effusion  of 
blood,  and  bruises  of  the  neighboring  parts.  It  is  manifestly 
impossible,  from  the  disproportion  between  the  sexual 
organs,  that  a  rape  could  be  perpetrated  by  a  man  upon 
a  young  child  without  being  attended  with  severe  local 
injuries  to  the  latter. 

If  the  child  be  examined  within  two  or  three  days  after 
the  act,  the  following  signs  will  usually  be  found  :  inflam- 
mation and  tumefaction  of  the  vulva,  with  some  abrasion  of 
the  mucous  membrane  ;  a  muco-purulent  discharge  from 
the  vagina,  of  a  yellowish  or  greenish-yellow  color  and 
ropy  consistence,  staining  and  stiffening  the  girl's  linen  ; 
painful  urination,  arising  from  the  inflammation  being  ex- 
tended to  the  urethra  ;  clots  of  blood  lying  within  the  vulva 
and  blood  oozing  from  the  abraded  membrane.  The  hymen 
may  be  found  either  destroyed  or  lacerated,  or  very  possi- 
bly not  injured  at  all.  In  relation  to  the  condition  of  the 
hymen  in  very  young  children,  it  should  be  remembered 
that  in  them  it  presents  a  variety  of  conformation,  some- 
times being  veiy  far  back  in  the  vulva,  so  as  to  render  it 
difficult  to  find  ;  in  such  cases  it  may  entirely  escape  lacer- 
ation. In  fifty-four  cases  of  actual  rape  upon  children, 
many  of  them  under  fourteen  years  of  age,  and  complicated 
with  syphilis,  Casper  found  the  hymen  uninjured  in  four 
fifths  of  the  number. 

Unnatural  dilatation  of  the  vagina  may  be  mentioned  as  a 
frequent  sequence  of  rape  on  young  children  ;  but  this  con- 
25 


298  MEDICAL   JURISPRUDENCE. 

dition  may  be  produced  by  the  passage  of  hard  bodies  in 
order  to  substantiate  a  false  charge.  Casper  once  examined 
a  girl  only  ten  years  old  whose  mother  had  gradually  dilated 
her  vagina  with  her  fingers  in  order  to  fit  her  for  sexual 
intercourse. 

In  making  an  examination,  in  the  case  of  an  alleged  rape 
on  a  child,  several  points  are  to  be  considered.  In  the  first 
place,  it  should  be  recollected  that  for  the  legal  establish- 
ment of  the  crime,  both  in  children  and  adults,  it  is  only 
necessary  that  vulval  penetration,  however  slight,  be  proven. 
It  is  not  required  that  the  hymen  should  be  destroyed.  It 
has  been  so  decided  repeatedly.  If  after  an  early  exami- 
nation no  marks  of  violence  about  the  sexual  organs  or 
other  portions  of  the  person  are  discovered,  this  would 
be  a  strong  presumption  against  the  validity  of  the  charge. 
On  the  other  hand,  the  mere  presence  of  marks  of  violence 
about  the  pudendum  is  not  of  itself  sufficient  to  prove  a 
rape,  since  these  are  sometimes  inflicted  purposely  upon 
young  children  by  designing  mothers  in  order  to  make 
out  a  false  charge  against  an  innocent  man.  Further,  the 
absence  of  the  hymen  is  not  of  itself  a  proof  of  rape,  since 
this  membrane  may  have  been  previously  destroyed  by 
suppurative  inflammation,  or  by  ulceration,  also  by  accident, 
or  even  designedly,  in  order  to  substantiate  a  false  charge. 

The  question  whether  venereal  disease  could  be  com- 
municated to  young  children  otherwise  than  by  sexual 
contact  must  be  answered  aflRrmatively,  as  by  the  use  of 
sponges  or  cloths  which  have  been  previously  employed 
by  adults  affected  with  these  disorders.  Such  instances, 
however,  are  rare  ;  but  they  might  be  accepted  as  probable 
where  no  signs  of  violence  or  soreness  of  the  parts  existed. 
The  muco-purulent  discharge  which  invariably  follows  upon 


RAPE.  299 

the  defloration  of  a  young  girl  should  not  be  confounded 
either  with  gonorrhea  or  with  infantile  leucorrhea.  The 
latter  disorder  is  of  spontaneous  origin,  and  is  very  com- 
mon among  children  of  the  lowest  orders  whose  hygienic 
surroundings  are  bad.  The  existence  of  this  discharge  is 
not  infrequently  made  the  ground  of  complaint  against  an 
innocent  man  for  a  felonious  assault  upon  the  person  of  the 
young  girl,  who  has  been  previously  tutored  to  tell  her 
story,  even  to  its  minutest  details.  In  cases  of  this  kind  it 
is  always  best  to  examine  the  child  apart  from  all  her  asso- 
ciates, but  in  the  presence  of  a  competent  third  party  if 
possible. 

Gangrenous  inflammation  of  the  vulva  is  more  rare  than 
infantile  leucorrhea  ;  it  sometimes  prevails  epidemically,  and 
occurs  as  a  sequel  to  low  fevers  and  other  prostrating 
diseases ;  it  is  found  almost  exclusively  among  neglected, 
filthy  children,  suffering  from  exhaustion  and  want  of  food. 
The  mortification  in  these  cases  frequently  terminates  fatally. 

To  diagnosticate  properly  between  these  spontaneous 
infantile  diseases  and  gonorrhea  or  a  muco-purulent  dis- 
charge, the  examiner  should  remember  that  a  true  gonor- 
rheal discharge  does  not  come  on  until  about  the  fourth  to 
the  eighth  day,  and  is  usually  very  profuse — much  more  so 
than  that  which  results  simply  from  the  violence  of  deflo- 
ration ;  also,  that  its  duration  is  much  longer.  Casper 
recommends  that  in  doubtful  cases  a  second  examination 
should  be  made  in  the  course  of  a  week  or  ten  days.  If 
the  purulent  discharge  has  then  ceased,  or  is  about  ceasing, 
there  is  good  reason  to  believe  that  it  was  not  due  to 
gonorrhea.  Again,  if  the  muco-purulent  flow  is  of  spon- 
taneous origin  (leucorrhea),  there  will  be  an  absence  of 
blood ;  whereas,  if  it  be  due  to  violence  (rape),  there  will 


300  MEDICAL   JURISPRUDENCE. 

always  be  more  or  less  effusion  of  blood,  along  with  dilata- 
tion, and  probably  laceration  of  the  vagina  and  rupture  of 
the  perineum.  The  discovery  of  the  specific  microbe  will 
aid  materially  in  this  examination.  In  all  such  cases  the 
person  of  the  accused  should  be  examined  for  evidences  of 
gonorrhea,  and  also  for  blood  stains  upon  his  person  or 
clothes  ;  but  the  absence  of  the  latter  would  be  no  proof 
that  he  had  not  committed  the  crime,  since  the  bleeding  of 
the  pudendum  may  not  have  taken  place  until  after  the  act. 
Several  cases  of  this  character  have  been  reported.  More- 
over, the  discovery  of  seminal  stains  upon  either  the 
accused  or  the  victim  might  be  regarded  as  positive  proof 
of  guilt,  unless  it  could  be  shown  that  a  previous  and  recent 
defloration  has  occurred. 

Rape  on  young  children  has  not  infrequently  resulted  in 
death  ;  the  violent  laceration  of  the  vagina  and  perineum 
producing,  in  some  instances,  mortification,  and  in  others 
fatal  peritonitis. 

Rape  on  Adult  Females.  —  The  question  is  frequently 
raised  as  to  the  possibility  of  a  rape  being  committed  by 
one  man  upon  a  healthy,  vigorous,  adult  woman.  A  deter- 
mined and  vigorous  resistance  may  prevent  the  perpetration 
of  the  crime.  On  the  other  hand,  the  woman  may  be  forced 
to  yield  through  fear  of  her  life,  or  duress,  or  may  be 
actually  overpowered  through  superior  strength,  or  fraudu- 
lently deceived  by  the  administration  of  narcotics  or  anes- 
thetics. Casper  gives  an  instance  where  a  healthy  woman, 
twenty-five  years  old,  was  violated  by  a  single  man.  Every 
case  of  this  character  must  be  judged  on  its  own  merits. 
The  physician  has  simply  to  state,  from  an  examination  of 
the  parties,  that  sexual  intercourse  has  taken  place,  leaving 


Rap^.  301 

the  jury  to  decide  whether  or  not  rape  has  been  perpe- 
trated. Doubtless,  in  some  of  the  many  false  accusations 
of  rape,  Sancho  Panza's  mode  of  sifting  the  evidence  and 
his  subsequent  judgment  in  the  case,  during  his  brief 
though  brilliant  experience  as  Governor  of  Barataria,  might 
be  held  up  as  a  safe  guide  to  follow.  In  some  cases  there 
are  accomplices  to  the  crime,  when,  of  course,  there  can  be 
no  hesitation  as  to  the  possibility  of  overcoming  the  resist- 
ance of  the  victim  by  mere  brute  force. 

It  must  also  be  admitted  that  rape  may  be  perpetrated 
on  adult  women  when  rendered  unconscious  by  means  of 
powerful  narcotics  or  anesthetics,  or  when  thrown  into  the 
mesmeric  condition,  or  when  in  syncope  or  the  coma  of 
apoplexy ;  but  whether  the  act  can  be  accomplished  when 
the  female  is  merely  in  a  profound  natural  sleep,  and  uncon- 
sciously to  herself,  is  a  question  which  admits  of  consider- 
able discussion.  The  cases  of  this  character  are  certainly 
exceptional ;  but  their  possibility  must  be  admitted  —  cer- 
tainly in  the  case  of  women  accustomed  to  sexual  inter- 
course, but  very  doubtful  in  the  case  of  virgins ;  although 
we  may  not  deny  the  possibility  even  in  the  latter,  inas- 
much as  authenic  instances  are  mentioned  by  reliable 
authors.  There  will  always  necessarily  be  more  or  less 
doubt  in  the  matter,  and  the  oft-quoted  dictum  of  Valentin 
deserves  consideration  :  "  non  omnes  dormiunt  qu(2  clauses 
habetit  oculos.'^ 

A  question  of  much  importance  is  whether  the  anesthetic 
effects  of  ether  or  chloroform  are  capable  of  so  completely 
abolishing  consciousness  and  sensibility  on  the  part  of  a 
woman,  especially  a  virgin,  as  to  permit  the  successful  per- 
petration of  a  rape.  A  somewhat  remarkable  case  involv- 
ing this  question  was  tried  in  Philadelphia  in    1854.     The 


302  MEDICAL   JURISPRUDENCE, 

plaintiff  was  a  young  lady  of  unimpeachable  character,  who 
charged  a  very  respectable  dentist  with  committing  a  rape 
upon  her  while  in  his  office  and  under  the  anesthetic  influ- 
ence of  ether  for  the  purpose  of  an  operation  upon  her 
teeth.  She  averred  very  positively  in  her  testimony  that 
she  was  conscious  of  his  "entering  her  person,"  and  then 
"  felt  pain,"  but  she  "  was  not  able  to  cry  out  or  resist,"  and 
"  all  this  time  was  conscious  of  everything  that  was  going 
on."  She  afterward  "  opened  her  eyes,"  and  again  "  closed 
them  immediately."  After  this  alleged  liberty  she  states 
that  she  inhaled  the  ether  a  second  time,  at  the  doctor's 
request,  in  order  to  have  a  tooth  extracted.  When  this  was 
over  she  made  a  second  appointment  with  him  for  some 
days  after.  She  parted  with  the  dentist  at  his  front  door 
without  making  any  complaint,  leaving  a  kindly  message 
for  a  mutual  acquaintance.  From  his  office  she  walked  a 
considerable  distance  to  a  friend's  house,  stopping  on  the 
way  at  a  confectioner's  to  partake  of  ice  cream.  After  her 
visit  to  her  friend  she  again  walked  quite  a  distance  to 
another  friend's  house,  where  she  remained  several  hours, 
and  after  tea  on  that  same  evening  first  informed  any  one 
of  the  alleged  outrage ;  and  on  the  same  afternoon  her 
catamenia  appeared,  which  was  her  regular  time.  She 
further  stated  that  "  she  did  not  examine  her  person  before 
the  appearance  of  the  menses,  nor  did  anybody  examine 
her  garments  before  two  days  had  elapsed.  She  was  never 
examined  by  any  physician."  Her  complaint  was  lodged 
before  the  authorities,  and  the  defendant  was  arrested,  tried, 
convicted,  and  imprisoned  for  a  term  of  years. 

The  general  opinion  of  the  medical  and  legal  professions, 
both  at  the  time  of  this  trial  and  since,  was  that  this  convic- 
tion was  unjust,  and  unwarranted  by  the  circumstances  of 


RAPE.  303 

the  case.  The  most  serious  defect  in  the  evidence  was  the 
total  absence  of  any  medical  examination  to  prove  the 
recent  defloration  of  the  plaintiff.  It  really  appears  to  us 
unaccountable  how  such  a  grave  charge  could  have  been 
for  a  moment  entertained  by  the  court  and  juiy  against  a 
man  of  unsullied  character  in  the  absence  of  this  most  im- 
portant link  in  the  chain  of  evidence.  We  must  suppose  it 
to  have  been  one  of  those  instances  mentioned  by  Sir  Mat- 
thew Hale,  "wherein  the  court  and  jury  may,  with  so  much 
ease,  be  imposed  upon  without  great  care  and  vigilance,  the 
heinousness  of  the  offense  many  times  transporting  the 
judge  and  jury  with  so  much  indignation  that  they  are  over- 
hastily  carried  on  to  the  conviction  of  the  persons  accused 
thereof,  by  the  confident  testimony  of  sometimes  false  and 
malicious  witnesses."  The  defendant  practised  dentistry 
for  many  years  in  reputable  professional  standing. 

The  important  point  in  the  above  and  similar  cases  is 
whether  an  individual  under  the  influence  of  anesthesia 
has  such  complete  control  over  the  mental  faculties  as  to 
fully  recognize  and  appreciate  what  is  transpiring  around 
her,  and  afterward  to  minutely  describe  all  the  particulars, 
and  yet,  at  the  same  time,  lose  the  power  of  resistance  ? 
Such  an  abolition  of  the  will  as  to  destroy  all  power  of  re- 
sistance implies  a  narcotism  so  complete  as  to  produce 
complete  unconsciousness.  Nothing  is  more  certain  than 
that  in  such  a  person  the  sense  of  external  impressions 
becomes  at  first  very  confused,  and  very  soon  is  entirely 
obliterated.  The  most  painful  operations  seem  to  produce 
no  sensation  whatever.  As  to  the  perceptions,  they  soon 
become  perverted  ;  the  person  passes  rapidly  into  dream- 
land, "  the  inward  perceptions  of  the  mind  being  sometimes 
of  the  most  agreeable,  and  at  others  of  the  most  painful 


304  MEDICAL   JURISPRUDENCE, 

character ;  and  these  dreams  may  or  may  not  be  pertinent 
to  the  actual  position  of  the  patient." 

But  it  is  especially  upon  the  emotions  that  the  effects  of 
etherization  are  most  conspicuous  ;  some  exhibit  signs  of 
irrepressible  mirth,  while  others  appear  weighed  down  by 
despondency  or  excited  to  violent  anger.  Women  are 
especially  liable  to  be  thus  affected,  and  in  some  the  erotic 
feelings  are  unquestionably  excited  to  a  high  degree.  We 
have  frequently  witnessed  this  ourselves  in  female  patients, 
and  the  fact  is  abundantly  corroborated  by  others.  The 
case  just  alluded  to  was  of  a  character  precisely  suited  to 
illustrate  this  point.  The  young  lady  was  betrothed  in 
marriage  ;  she  was  accompanied  by  her  lover  in  her  walk 
to  the  dentist's  ;  she  was  just  at  her  menstrual  period. 
What  more  natural,  under  such  circumstances,  and  when 
her  senses  were  "  stolen  away  "  by  the  anesthetic,  than  that 
her  dreams  or  false  perceptions  should  take  the  direction 
which  should  give  rise  to  erotic  emotions  and  sensations  ? 
That  this  is  not  mere  speculation  is  shown  by  well-attested 
facts.  M.  Dubois  relates  a  case  under  his  own  observation 
where  a  woman  undergoing  an  operation,  under  the  influ- 
ence of  ether,  drew  an  attendant  toward  her  to  kiss  him  as 
she  was  lapsing  into  insensibility ;  and  she  afterward  con- 
fessed to  dreaming  of  coitus  with  her  husband  while  she  lay 
etherized.  Another  case  closely  resembling  the  one  now 
under  consideration  occurred  in  Montreal  in  1858.  A 
dentist  was  indicted  for  attempting  to  commit  a  rape  upon 
one  of  his  patients  under  the  influence  of  chloroform.  At 
the  trial  a  witness  testified  that  his  wife  was  under  the 
strongest  impressions  that  she  had  been  violated  while 
under  the  influence  of  chloroform  ;  yet  the  husband  had 
been  present  during  the  whole  time. 


RAtfi.  305 

In  such  cases,  therefore,  extreme  caution  should  be  exer- 
cised in  receiving  the  testimony  of  a  prosecutrix  who  was 
under  anesthetic  influence,  unless  her  statement  is  corrobo- 
rated by  a  proper  medical  examination. 

Medical  Evidences  of  Rape  on  Adttlts.  —  In  the  majority 
of  these  cases  the  examination  is  postponed  so  long  as  to 
afford  very  few  satisfactory  data  to  the  physician,  since  all 
traces  of  violence  in  adults  may  disappear  in  a  few  days. 
If  much  resistance  has  been  offered  there  will  generally  be 
found  bruises  upon  the  thighs  and  legs,  and  possibly  upon 
the  arms  and  trunk,  and  even  on  the  neck,  when  an  attempt 
at  partial  strangulation  has  been  made  ;  but  these  are  incon- 
clusive of  rape  without  the  presence  of  marks  of  violence 
upon  the  pudendum.  Besides,  they  may  be  produced  by 
the  woman  herself,  in  order  to  substantiate  a  false  accusa- 
tion. In  children,  for  obvious  reasons,  these  marks  of 
violence  do  not  occur.  The  truly  important  medical  signs 
are  derived  from  the  condition  of  the  hymen  and  of  the 
sexual  organs,  and  from  the  presence  of  seminal  and  blood 
stains.  It  should  be  remembered  that  these  physical 
marks  of  rape  about  the  genital  organs  may  be  found 
whether  the  connection  has  been  voluntary  or  involuntary. 

Thus,  rupture  of  the  hymen,  laceration  of  the  vagina,  swell- 
ing and  soreness  of  the  organs,  effusion  and  coagula  of 
blood,  stains  of  semen  and  blood  upon  the  person  and 
clothing,  may  be  met  with  in  both  cases. 

Another  circumstance  to  be  recollected  is  that  girls  and 
young  women  are  liable  to  a  muco-purulent  discharge  aris- 
ing from  vaginitis,  somewhat  similar  to  that  already  noticed 
as  found  in  young  children  under  bad  hygienic  conditions. 
Older  women  are  liable  to  leucorrhea,  which  may  some- 
26 


306  MEDICAL    JURISPRUDENCE. 

times  be  accompanied  with  an  ulcerated  state  of  the  vagina 
and  general  soreness  and  swelling  of  the  parts.  It  is  pos- 
sible that  a  woman  thus  affected  might  bring  a  false  charge 
of  rape  against  an  innocent  man,  alleging  that  her  present 
condition  was  the  result  of  a  rape.  Although  an  ordinary 
leucorrhea  can  readily  be  distinguished  from  a  gonorrhea, 
—  the  discharge  of  the  latter  being  purulent,  while  it  is 
mucous  in  the  former, — yet  a  purulent  discharge  may  take 
place  from  the  vagina,  as  the  result  of  an  intense  vaginitis, 
quite  independently  of  sexual  intercourse ;  and  such  a  dis- 
charge cannot  readily  be  distinguished  from  that  of  gonor- 
rhea. Taylor  very  properly  remarks  that  "  such  discharges, 
commencing  before  but  continuing  and  sometimes  becom- 
ing aggravated  after  marriage,  have  given  rise  to  unfounded 
suspicions  of  infection  from  venereal  disease  imparted  by 
the  husband,  and  have  thus  led  to  suits  for  divorce." 

Condition  of  the  Hymen  —  Virginity.  —  Much  has  been 
said  about  the  unruptured  condition  of  the  hymen  being 
accepted  as  a  proof  of  chastity  or  of  virginity,  and  unques- 
tionably in  the  great  majority  of  cases  this  is  true ;  but  it 
cannot  be  affirmed  absolutely  and  without  exception,  inas- 
much as  authentic  instances  are  recorded  where  the  hymen 
has  been  destroyed,  either  by  accident,  disease,  self-abuse, 
or  by  a  surgical  operation  to  allow  the  escape  of  the 
menses ;  and,  on  the  other  hand,  where  sexual  intercourse 
has  been  continued  for  years  with  the  hymen  unruptured, 
and  where  even  pregnancy  had  resulted,  and  it  became 
necessary  to  divide  the  membrane  with  a  knife  before  de- 
livery could  be  accomplished. 

In  the  exceptional  cases  just  alluded  to,  of  the  persist- 
ence of  the  hymen  after  repeated  intercourse,  this  anomaly 
may  be  ascribed,  according  to  high  authorities,  to  an  abnor- 


RAPE.  307 

mally  firm,  hard,  and,  resisting  structure  of  the  membrane, 
due  to  the  presence  of  a  fibrous  or  fibro-elastic  tissue.  It 
therefore  must  follow,  from  all  the  above  facts,  that  the  loss 
of  the  hymen  is  not  an  infallible  proof  of  a  loss  of  chastity  ; 
nor  does  the  existence  of  a  hymen  constitute  an  absolute 
evidence  of  its  presence.  Casper,  however,  considers  "  that 
where  a  physician  finds  a  hymen  still  preserved,  even  its 
edges  not  being  torn,  and  along  with  it  (in  young  persons) 
a  virgin  condition  of  the  breasts  and  external  genitals,  he  is 
then  justified  in  giving  a  positive  opinion  as  to  the  existence 
of  virginity,  and  vice  versa!' 

The  other  external  evidences  connected  with  the  sexual 
organs,  such  as  swelling  and  soreness  of  the  vulva,  the 
presence  of  effused  blood  and  of  seminal  stains,  would  all 
afford  strong  corroborative  proof  of  rape,  provided  want  of 
consent  could  be  satisfactorily  shown  and  an  early  exami- 
nation be  made. 

Blood  and  Seminal  Stains. — These  may  be  found  upon 
the  persons  and  clothing  of  both  the  ravisher  and  his 
victim.  If  the  garments  are  tolerably  clean,  there  should 
be  no  difficulty  in  recognizing  these  spots ;  but  they  are 
frequently  presented  for  examination  in  such  a  filthy  con- 
dition as  to  render  their  identification  very  difficult.  More- 
over, a  mistake  may  arise  from  the  woman's  garments  being 
intentionally  soiled  with  blood,  in  cases  of  false  accusation. 

The  manner  of  examining  blood  stains  has  already  been 
explained. 

Examination  of  Seminal  Spots. — These  stains  cause  a 
stiffening  of  the  fabric,  like  those  produced  by  albumin  or 
gum.  The  seminal  stain  may  be  identified  as  follows :  If 
gently  warmed,  it  will  assume  a  pale  yellow  color.  If 
moistened  with  warm  water,  it  will  emit  the  seminal  odor. 


308  MEDICAL   JURISPRUDENCE. 

Cut  out  the  suspected  stain  and  place  it  in  a  watch  glass, 
adding  a  few  drops  of  pure  water  and  gently  squeezing  it 
with  a  glass  rod  until  thoroughly  soaked  ;  remove  the  frag- 
ment and  add  a  drop  of  nitric  acid  on  a  glass  rod,  when 
the  liquid,  if  seminal,  will  turn  a  yellow  color,  without  giv- 
ing a  precipitate.  The  best  results  will  be  obtained  by 
placing  a  small  fragment  of  the  stained  material  on  an 
ordinary  microscopic  slide,  moistening  it  with  a  drop  of  dis- 
tilled water,  and  placing  over  it  a  cover-glass.  After  soak- 
ing for  a  short  time  (30  to  60  min.)  the  cover-glass  is 
rocked  by  pressing  on  alternate  sides,  thus  causing  a  cur- 
rent of  water  to  flow  through  the  fabric,  from  which  the 
spermatozoids  will  gradually  float  out.  Several  slides 
should  be  prepared  from  each  stain.  If  very  good  results 
follow  the  application,  the  cover-glass  and  fabric  may  be 
removed  and  the  slide  dried  and  preserved ;  under  ordi- 
nary circumstances  such  results  are  not  attainable.  If  the 
water  used  in  the  test  be  slightly  tinted  by  eosin  or  methyl 
blue,  the  spermatozoids  will  take  up  the  dye,  and  may  be 
more  easily  detected.  Cut  out  a  fragment  containing  the 
stain  and  treat  it  with  distilled  water  as  above  described. 
After  sufficient  soaking,  apply  a  drop  of  the  liquid  to  a 
glass  slide  and  place  it  under  the  microscope,  using  a  very 
high  power. 

The  spermatozoids  have  a  characteristic  appearance. 
They  vary  considerably  both  in  numbers  and  size.  On  an 
average,  the  human  spermatozoid  is  about  the  q^-^  of  an 
inch  in  length,  having  a  flattened,  ovoid  head,  which  is 
about  one  third  the  diameter  of  a  human  blood  corpuscle. 
Attached  to  this  head  is  a  thread-like,  tapering  tail,  that  is 
eight  to  ten  times  longer  than  the  head.  Very  often,  in 
old  seminal   stains  the  spermatozoids  will  be  found  only  in 


RAPE.  309 

a  fragmentary  state,  and  the  examiner  should  be  cautioned 
not  to  confound  these  with  fibrillae  and  other  bodies  which 
might  be  accidentally  present.  The  absence  of  spermato- 
zoids  is  not  to  be  regarded  as  conclusive  that  the  spot  is 
not  seminal,  since,  as  Casper  and  others  have  shown,  the 
seminal  fluid  does  not  always  contain  them  ;  they  may  be 
absent  in  certain  debilitating  diseases,  after  excessive  venery, 
and  in  very  aged  men. 

These  bodies  exist  in  the  semen  of  all  animals  capable  of 
procreation,  and  they  are  found  in  man  from  the  age  of 
puberty  to  a  very  advanced  period  of  life. 

It  is  possible  to  mistake  fragments  of  the  spermatozoids 
for  fibrils  of  linen  and  other  fabrics  washed  out  at  the  time 
of  the  examination.  A  proper  degree  of  caution,  together 
with  a  knowledge  of  the  peculiar  microscopic  appearance  of 
these  fibrils,  should  prevent  this  mistake.  Hence,  in  such 
an  investigation  it  is  safest  not  to  decide  upon  the  seminal 
character  of  the  stain  unless  one  or  more  complete  sper- 
matozoids are  found. 

M.  Donne  has  described  an  organism  called  by  him 
Trichomonas  vagincB.  It  is  found  in  vaginal  mucus,  and 
resembles  the  spermatozoids,  but  differs  in  having  the  head 
three  times  as  large  ;  it  is  also  granular,  and  armed  with  a 
row  of  four  or  six  cilia. 

The  spermatozoids  appear  to  retain  life  long  after  the 
death  of  the  body.  Hoffmann  observed  active  move- 
ments in  them  from  eighty  to  one  hundred  hours  after 
death.  In  the  dried  state  they  may  be  identified  years 
afterward. 

In  some  cases  of  alleged  rape  it  may  be  necessary  to 
examine  the  vaginal  secretion  for  evidence  of  recent  inter- 
course.    If  this  has   occurred,    the  presence  of  the  sper- 


3  lO  MEDICAL   JURISPRUDENCE. 

matozoa  may  easily  be  discovered  by  placing  a  drop  of  the 
mucus  upon  a  glass  slide  and  subjecting  it  to  microscopic 
examination.  It  has  been  shown  by  Miiller  that  the  sper- 
matozoids  will  retain  life  and  activity  for  eight  days  in  the 
vaginal  mucus. 

Posner  has  recently  published  some  experiments  on  the 
test  for  seminal  fluid  called  the  Florence  reaction.  A  strong 
solution  of  iodin  in  potassium  iodid  and  water  added  to 
fresh  semen  produces  numerous  dark-brown  crystals  of 
various  forms.  The  reaction  does  not  depend  on  the  pres- 
ence of  spermatozoids.  Extract  from  the  ovary  also  gives 
these  crystals.     The  reaction  is  not  peculiar  to  semen. 

Post-mortem  evidence  of  Rape,  —  The  physician  is  some- 
times required  to  determine  the  fact  of  violation  previous  to 
death  when  a  murder  has  been  committed.  The  difficulty 
here  is,  of  course,  increased  by  the  absence  of  evidence  from 
the  woman.  The  proofs  of  violation  in  the  case  of  a  very 
young  girl  would  be  easily  made  out ;  but  in  the  case  of  an 
adult,  even  if  the  evidence  of  rupture  of  the  hymen  and 
vulval  swelling  and  effused  blood  pointed  to  a  recent  deflora- 
tion, this  would  not  prove  the  want  of  consent  on  her  part. 
If,  however,  there  existed  at  the  same  time  other  marks  of 
extreme  violence  upon  the  body,  this  would  be  strong  cir- 
cumstantial evidence  that  the  outrage  had  been  perpetrated 
before  the  murder. 

Cases  of  sexual  intercourse  with  the  dead  body  have 
occurred  at  all  periods  of  human  history.  Of  late  years 
several  cases  have  been  detected  among  morgue  keepers. 
Obviously,  there  will  be  difficulty  and  uncertainty  in  fasten- 
ing the  offense  on  any  one,  unless,  as  has  occasionally 
happened,  the  person  is  caught  in  the  act. 


RAPE.  311 

Rape  of  Females  on  Males.  —  This  crime  is  rarely  brought 
before  the  courts,  but  seems  to  be  more  common  than  has 
generally  been  supposed.  Boys  are  occasionally  induced 
or  forced  into  sexual  intercourse  with  adult  women  to 
gratify  the  erotic  feelings  of  the  latter  without  the  danger 
of  pregnancy.  A  boy  seven  years  old,  with  well-marked 
gonorrhea,  presented  himself  for  treatment  at  the  clinic  of 
the  Jefferson  Medical  College  Hospital.  He  stated  that  he 
had  contracted  the  disease  by  gratifying  the  erotic  desires 
of  a  married  woman  whose  husband  was  at  sea. 

Unnatural  Crimes. — Sodomy — Pederastia  ;  Bestiality.  — 
Sodomy,  or  Pederastia,  is  the  unnatural  intercourse  of  man 
with  man.  Bestiality  implies  unnatural  intercourse  with 
animals.  Both  acts  are  criminal,  and  are  regarded  by  the 
law  as  felonious,  and  are  punished  in  England  by  penal 
servitude  and  in  this  country  by  imprisonment  for  a  term 
of  years. 

In  the  case  of  sodomy,  both  the  parties  are  held  to  be 
equally  guilty,  unless  it  can  be  shown  that  one  was  not 
consenting,  was  under  age,  was  unconscious  at  the  time,  or 
was  idiotic  or  insane.  The  facts  of  -this  crime  are  usually 
proved  without  medical  evidence,  except  in  the  case  of 
young  persons,  when  marks  of  physical  violence  will  usu- 
ally be  sufficiently  apparent.  Collateral  proof  would  be 
given  by  the  discovery  of  seminal  stains  upon  the  person 
or  linen. 

Unless  the  examination  be  made  soon  after  the  perpetra- 
tion of  the  act,  all  evidence  of  it  will  have  disappeared,  just 
as  in  cases  of  rape.  In  those  habituated  to  this  vice,  there 
are,  according  to  Casper  and  Tardieu,  certain  alterations  of 
the  parts  that  may  be  regarded  as  characteristic,  such  as  a 


312  MEDICAL   JURISPRUDENCE. 

funnel-shaped  condition  of  the  anus,  which  is  enlarged, 
smooth,  and  even  patulous,  the  folds,  or  rugae,  having  dis- 
appeared. There  may  also  be  other  marks  around  the 
anus,  such  as  cicatrices,  chancres,  and  venereal  warts.  In 
recent  cases,  laceration  of  the  sphincter  ani,  fissures,  and 
bruises,  with  effusion  of  blood,  might  all  be  observed. 

Legal  Relations  of  Rape.  —  The  crime  is  not  excused  if 
the  woman  has  submitted  — 

(i)  From  stupefaction,  produced  either  by  disease  (coma) 
or  by  drugs  —  including  alcohol,  chloroform,  and  ether  — 
or  by  hypnotism.  Although,  in  such  cases,  the  violation, 
strictly  speaking,  be  not  against  her  will,  it  is  without  her 
will,  which  is  regarded  as  the  same  thing.  This  is  true, 
even  if  it  can  be  shown  that  the  drug  was  administered  for 
the  purpose  merely  of  exciting,  and  not  stupefying.  It 
is  vastly  important  that  the  distinction  should  be  clearly 
drawn  between  the  erotic  sensations  and  perverted  impres- 
sions of  a  female  while  under  an  anesthetic  influence  for 
surgical  operations,  and  who  may  subsequently  institute  a 
false  accusation,  and  similar  sensations  resulting  from  the 
criminal  administration  of  chloroform  or  ether  for  this  veiy 
intent,  and  where  the  will  or  resisting  power  appears  to  be 
taken  away  before  the  anesthesia  is  complete. 

(2)  From  Ignorance  of  the  Nature  of  the  Act.  —  Such 
instances  occur  in  young  children,  and  in  older  women  who 
are  idiotic  or  insane.  In  some  recent  cases,  both  in  this 
country  and  in  England,  it  has  been  held  that,  in  dementia 
not  amounting  to  positive  idiocy,  if  consent  were  given,  and 
no  compulsory  force  employed,  it  does  not  constitute  rape. 

(3)  From  Mistake  of  Person.  —  More  than  one  case  has 
been  reported  in  which  a  married  woman  was  raped  in  her 
sleep,  supposing  she  was  embraced  by  her  husband. 


RAPE.  313 

(4)  From  Fear. — Submission  extorted  through  fear  of 
death  or  violent  threatening  is  no  excuse  for  the  act. 

(5)  From  Prior  Want  of  Character  of  the  Prosecutrix.  — 
Prior  want  of  character  in  the  woman  is  no  ground  of  excuse 
for  the  crime,  if  it  was  perpetrated  by  force  and  against 
her  will  ;  not  even  if  she  were  a  common  prostitute  or  the 
mistress  of  the  defendant.  The  allegation  of  unchastity  in 
the  woman  could  further  be  supported  by  a  medical  exami- 
nation, which  might  reveal  the  existence  of  syphilis  or 
gonorrhea.  This  examination  is  not  compulsory ;  the 
woman  is  not  obliged  to  convict  herself 

(6)  Subsequent  Suppression  of  the  Fact  by  the  Prosecu- 
trix. —  If  the  alleged  violation  be  suppressed  by  the  women 
for  such  a  time  as  to  prevent  any  evidence  being  obtained 
by  a  medical  examination,  this  will  go  very  far  in  lessening 
the  credibility  of  her  testimony.  Not  a  few  instances  of  this 
character  have  turned  out  to  be  cases  of  false  accusation. 

(7)  Want  of  Age  and  of  Sexual  Capacity  of  the  Defendant. 
—  According  to  the  law,  a  child  under  a  certain  age  is  pre- 
sumed to  be  incapable  of  committing  a  rape,  though  he 
may  be  convicted  of  an  assault  with  intent  to  ravish.  The 
want  of  .sexual  capacity  is  purely  a  medical  question  to  be 
determined  at  the  time. 


CHAPTER  XIII. 

INSANITY. 

In  a  work  like  the  present,  it  would  be  impossible  to 
enter  into  an  extended  discussion  of  the  subject  of  Insanity. 
Reference  must  be  made  to  the  many  admirable  treatises 
now  accessible,  both  in  English  and  foreign  languages.  All 
that  can  be  accomplished  is  to  present  the  subject  under 
certain  particular  phases,  with  a  special  reference  to  its 
medico-legal  relations,  so  as  to  enable  the  student  to  under- 
stand the  proper  professional  position  in  reference  to  that 
class  of  persons  who  have  been  deprived  of  reason  —  how 
to  determine,  first  of  all,  the  fact  of  their  insanity,  and, 
secondly,  its  degree,  as  involving  the  all-important  question 
of  their  civil  and  criminal  responsibility. 

The  physician  may  encounter  considerable  difficulties  in 
cases  of  real  or  alleged  insanity.  In  the  first  place,  there  is 
the  difficulty,  if  not  the  actual  impossibility,  of  determining 
the  precise  boundary  between  normal  and  abnormal  mental 
action,  just  as  it  is  often  impossible  to  do  in  the  case  of 
bodily  health  and  bodily  disease.  Even  in  respect  to  the 
individual  mental  powers  or  faculties,  the  greatest  variation 
is  observed.  Rarely  do  we  find  in  society  a  specimen  of  a 
perfectly  normal  and  harmonious  adjustment  of  all  the 
powers  of  the  mind.  Scarcely  ever  is  a  person  discovered 
in  whom  no  one  of  the  mental  faculties  is  allowed  to  exert 
an  undue  preponderance.  "  On  the  one  hand,  for  instance, 
individuals  are  observed  who  possess,  along  with  a  wondrous 
power  of  memory,  just  as  feeble  a  power  of  judgment; 

314 


INSANITY.  315 

while  others  to  the  most  vivid  powers  of  imagination  con- 
join a  most  wretchedly  deficient  power  of  will.  In  one,  an 
excessive  vivacity  of  character  may  betray  its  possessor 
into  actions  which  may  raise  doubts  as  to  his  actual  sanity  ; 
whilst  in  another,  originality  of  character,  flashing  out  as 
true  genius,  may  so  stamp  its  pecuHarities  on  every  act  as 
to  require  a  sharp  observation  if  the  limits  of  sanity  have 
not  been  over-stepped."     (Casper.) 

Another  great  difficulty  in  deciding  this  matter  arises 
from  the  impossibility,  often,  of  discovering  the  motives  of 
any  action,  even  the  most  extraordinary.  Whilst  the  ab- 
sense  of  all  rational  motive  may  usually  be  regarded  as 
indicative  of  an  insane  act,  we  must  not  be  too  ready  to 
admit  this  absence  in  any  particular  case,  since  these  motives, 
as  Casper  justly  remarks,  "may  be  so  deeply  buried  in  the 
soul  of  the  agent  as  frequently  to  baffle  the  greatest  experi- 
ence in  arriving  at  a  logical  conclusion."  The  subject  of 
motive  in  the  acts  of  the  insane  will  be  noticed  further  on. 

Still  another  difficulty  in  the  diagnosis  of  an  alleged 
mental  disorder  is  presented  by  the  possibility,  on  the  one 
hand,  of  its  being  feigned,  and,  on  the  other,  of  the  real 
disease  being  concealed  by  the  subject  with  the  most  con- 
summate art. 

All  the  medico-legal  questions  arising  out  of  insanity  are 
comprehended  under  the  twofold  inquiry  :  first,  as  to  the 
civil  responsibility  of  the  individual,  and,  secondly,  as  to 
his  criminal  responsibility.  These  two  points  cover  the 
whole  ground  of  a  medico-legal  investigation  in  every  case 
of  real  or  unsuspected  insanity. 

Civil  responsibility  means  the  capability  of  managing  the 
ordinary  affairs  of  civil  life,  such  as  the  entering  into  con- 
tracts, the  making  of  a  will,  the  performing  the  functions  of 


3l6  MEDICAL   JURISPRUDENCE, 

a  public  officer,  or,  in  common-law  phrase,  "  the  managing 
his  own  affairs." 

Criminal  responsibility  has  reference  solely  to  criminal 
acts,  and  involves  the  inquiry  whether  an  individual  commit- 
ting some  particular  crime,  such  as  murder,  theft,  or  arson, 
was  in  such  a  state  of  mind  at  the  time  of  the  commission 
of  the  deed  as  to  constitute  him  a  responsible  agent  ? 

One  other  point  is  to  be  noted  :  every  human  being  of 
responsible  age  and  sound  mind  is  conscious  of  possessing 
the  power  of  will,  or  of  moral  freedom  —  of  choosing  be- 
tween good  and  evil ;  and  although,  in  consequence  of 
faulty  training,  bad  associations,  and  the  power  of  tempta- 
tion, he  may  "  choose  the  evil,"  yet  he  is  fully  responsible 
for  this  choice  and  all  its  consequences,  provided  he  pos- 
sessed at  the  time  a  sound  mind. 

Legal  Terms. — Before  further  entering  upon  a  discus- 
sion of  the  subject,  it  will  be  proper  to  define  certain  legal 
terms.  A  medical  witness  should  confine  his  answers 
strictly  to  the  questions  put  to  him,  and  speak  of  insanity 
only  as  a  disease,  avoiding  the  tendency  to  theorize,  or 
speculate  upon  legal  distinctions. 

An  illusion  is  a  false  mental  impression  derived  through 
the  senses.  Real  things  are  distorted.  A  timid  person, 
for  instance,  may  mistake,  in  the  dark,  a  post  or  a  shrub 
for  a  man  ;  or  the  drapery  of  his  bed  curtains,  in  the  moon- 
light, may  be  distorted  into  an  apprehended  ghost.  Some- 
times the  false  impression  is  entirely  mental,  reproduced  by 
the  memory,  or  by  a  strong  effort  of  the  will,  recalling  the 
scenes  of  past  pleasures  or  sorrows,  the  features  and  per- 
sons of  friends,  and  even  the  tones  of  their  voices  and  other 
sounds.     Such  mental  images,  denominated  by  Rush  wak- 


INSANITY.  317 

ing  dreams,  are  called  spectral  illusions,  or  phantasms,  when 
they  have  reference  to  the  sense  of  sight,  although  the 
actual  vision  of  the  individual  may,  at  the  time,  be  defective, 
since  they  occur  equally  to  the  blind. 

The  distinctive  characteristic  of  an  illusion  is  that  the 
false  perception  can  be  soon  corrected  by  an  appeal  to  the 
other  senses  or  to  the  judgment.  If,  however,  it  is  persist- 
ently believed  to  have  a  positive  existence,  and  this  belief 
is  not  removed  either  by  reflection  or  by  a  reference  to  the 
other  senses,  then  the  illusion  becomes  a  delusion,  or  a  mis- 
leading of  the  mind,  and  it  indicates  a  disordered  mind. 

A  hallucination  is  also  a  perverted  perception,  but  with- 
out material  basis.  The  false  impressions  are  often  con- 
veyed through  the  organs  of  hearing.  If  the  individual  is 
able  to  correct  them  by  his  judgment,  or  by  reference  to 
his  other  senses,  they  are  of  no  significance  ;  but  if  they 
are  firmly  believed  in,  they  indicate  a  deranged  mental  con- 
dition. If  the  person  fancies  he  hears  strange  voices, 
constantly  urging  him  on  to  the  commission  of  some  horri- 
ble crime,  or  sees  purely  imaginary  personages,  these  are 
among  the  surest  indications  of  insanity. 

Some  writers  make  no  distinction  between  hallucinations 
and  illusions,  whilst  others,  and  we  think  very  properly, 
regard  them  as  differing  in  this  :  a  hallucination  is  an  unreal 
sensation  wholly  due  to  the  action  of  the  brain  ;  an  illusion 
is  a  real  sensation  —  that  is,  is  produced  by  some  real  object, 
although  distorted.  Nicolai,  the  Berlin  bookseller,  was  for 
years  troubled  with  seeing  unreal  objects  (spectral  illusions), 
and  sometimes  by  hearing  unreal  sounds  (hallucinations), 
but  he  did  not  believe  in  them  ;  hence  they  never  became 
delusions  in  his  case. 

A   delusion  is  a  belief  in   something  purely  imaginary, 


3l8  MEDICAL   JURISPRUDENCE. 

and  which  has  no  real  existence,  and  in  which  this  belief  can- 
not be  corrected  by  the  j  udgment,  nor  when  confronted  with 
contradictory  proof,  as,  e.  g.,  when  a  man  imagines  himself 
made  of  glass,  and  is  afraid  to  suffer  any  one  to  approach 
him,  lest  he  be  broken  to  pieces  ;  or  where  a  pauper  fancies 
himself  to  have  suddenly  become  a  milHonaire  or  a  king ; 
or  where  a  rich  man  imagines  himself  to  have  been  reduced 
to  beggary,  etc.  All  such  delusions  are  clear  manifesta- 
tions of  mental  disturbance.  In  legal  matters,  however, 
the  question  of  responsibility  (whether  civil  or  criminal) 
depends  upon  the  connection  of  the  act  with  the  particular 
delusion.  For  example,  if  the  delusion  is  such  as  to  pre- 
vent the  individual  from  exerting  a  "  rational  act  of  voli- 
tion "  in  the  matter  of  disposing  of  his  property  by  will  — 
as  when,  through  such  delusion,  the  result  of  disease,  he 
may  have  come  to  entertain  a  bitter  hatred  for  those  entitled 
to  his  love  and  gratitude  —  then  he  does  not  possess  testa- 
mentary capacity,  and  is,  so  far,  of  unsound  mind.  But  if 
the  delusion  be  upon  a  subject  entirely  disconnected  with 
the  act,  as  where,  for  example,  it  has  reference  to  his 
religious  state,  then  the  responsibility  of  the  individual  is 
not  necessarily  destroyed,  and  his  testamentary  capacity 
should  be  regarded  as  unaffected. 

The  existence  of  the  most  extraordinary  delusions  for 
years,  in  an  individual,  is  quite  consistent  with  an  otherwise 
apparently  sound  mental  condition.  Dr.  Reese  was  ac- 
quainted with  a  highly-educated  lady,  an  artist  of  consider- 
able abilities,  who  entertained  the  delusion  that  she  was,  in 
some  mysterious  manner,  incorporated  with  the  Holy 
Trinity,  and  that  she  received  direct  communications  from 
the  Father,  which  required  her  to  give  up  all  her  church 
relations  and   her  former  very  strict  orthodox  creed.     Yet 


INSANITY.  319 

this  lady  went  out  into  society,  conversed  intelligently  upon 
ordinary  subjects,  and  passed  generally  for  a  sensible 
woman. 

The  cunning  of  the  insane  in  concealing  their  delusions 
is  often  quite  remarkable.  Every  superintendent  of  an 
asylum  has  had  experience  of  it  in  patients  under  his  obser- 
vation. Perhaps  the  best  illustrations  are  afforded  in  cases 
in  which  patients,  who  wish  to  escape  from  an  asylum,  are 
brought  into  court,  under  writ  of  habeas  corpus,  for  their 
discharge,  and  where  they  so  skillfully  and  adroitly  pass 
their  examination  as  often  to  deceive  both  court  and  jury. 

An  oft-quoted  instance  of  the  above  will  bear  repetition 
here.  The  late  Lord  Erskine  was  engaged  in  a  case  in 
which  a  lunatic  had  brought  an  action  against  his  brother 
and  the  keeper  of  the  asylum  for  false  imprisonment.  The 
man  was  closely  interrogated  by  the  learned  lord  for  nearly 
the  whole  day,  without  his  being  able  to  elicit  anything  to 
prove  his  delusions,  when  a  gentleman  came  into  court  and 
suggested  to  the  learned  counsel  that  the  patient  believed 
himself  to  be  Jesus  Christ.  Lord  Erskine  immediately 
acted  upon  the  hint,  and  addressed  the  man  with  a  profound 
reverence,  suitable  to  his  assumed  character,  and  apologizing 
for  his  former  want  of  respect.  The  patient  at  once  ex- 
pressed his  forgiveness,  and,  with  the  utmost  gravity,  in  the 
face  of  the  whole  court,  said,  "Yes,  I  am  the  Christ." 

The  following  description  is  copied  from  J.  Dixon  Mann's 
work  on  Forensic  Medicine  and  Toxicology.  It  is  inserted 
because  it  is  a  vivid  and  typical  picture  of  the  course  of  a 
case  of  simple  insanity : 

"  Insanity  does  not  develop  in  a  moment ;  there  is  a  period 
of  ingravescence  during  which  the  individual  affected  grad- 
ually deviates  from  his  ordinary  mental  condition.    Although 


320  MEDICAL    JURISPRUDENCE. 

the  symptoms  evinced  during  the  various  stages  of  insanity- 
are  irregular  and  do  not  follow  any  definite  order,  certain 
of  them  are  of  common  occurrence,  some  of  which  are 
present  in  eveiy  case;  a  knowledge  of  these  symptoms  is 
essential  to  an  early  recognition  of  mental  disease..  The 
onset  of  insanity  may  be  so  insidious  that  long  before  any 
distinctive  indications  are  manifest  an  alteration  in  tempera- 
ment is  noticeable  ;  the  individual  is  different  from  what  he 
was  formerly  ;  he  has  lost  his  equanimity.  When  insanity 
begins  in  this  insidious  way  the  emotions  are  affected  long 
before  the  mind  is  impaired.  The  patient  is  subject  to  un- 
accountable waves  of  depression,  which  may  alternate  with 
periods  of  excitement ;  he  becomes  unwontedly  irritable 
and  is  unable  to  control  his  temper  under  the  petty  annoy- 
ances of  every-day  Hfe.  This  instabihty  of  temper  may  be 
the  condition  that  first  arouses  suspicion  in  the  minds  of  his 
friends  that  insanity  is  the  cause  of  the  change  in  dispo- 
sition. A  man  who  has  been  moody  and  reserved  in  his 
manner  for  some  time  is  credited  with  being  overtaxed  with 
business,  and  is  thought  to  be  a  little  out  of  sorts,  but  noth- 
ing more ;  at  some  trifling  contradiction  or  annoyance  he 
suddenly  blazes  up  into  a  frenzy  of  passion,  and  behaves 
for  the  moment  so  like  a  madman  that  the  bystanders  are 
at  once  impressed  with  the  idea  that  the  balance  of  his 
mind  is  impaired.  A  change  in  the  emotions  is  also  com- 
monly shown  by  transformation  of  like  into  dislike,  or  love 
into  hate.  A  man  shows  unwonted  impatience  at  the 
remarks  addressed  to  him  by  his  wife,  whose  opinion  he 
previously  valued,  and  then  manifests  an  absolute  antipathy 
to  her,  a  sentiment  totally  at  variance  with  their  former 
relations.  Loss  of  interest  in  objects  and  pursuits  which 
formerly  occupied  his  attention,  desire  for  solitude  perhaps 


INSANITY.  321 

at  first  shown  by  avoidance  of  social  intercourse  in  a  general 
way,  and  then,  in  a  more  special  manner,  by  seclusion  from 
the  family  circle,  are  further  evidences  of  perverted  senti- 
ments. At  this  period,  the  person  affected  is  often  quite 
capable  of  brightening  up  in  the  presence  of  strangers,  or 
of  friends  for  whom  he  has  a  special  liking  ;  he  will  even 
remark  that  he  feels  better  in  company — meaning  in  the 
society  of  those  with  whom  he  is  not  necessarily  brought 
into  relation. 

"  So  far  the  intellect  is  unimpaired.  The  capacity  to  fulfill 
the  duties  which  devolve  upon  a  merchant  or  professional 
man  may  be  equal  to  the  requirements ;  but  the  work  is 
done  in  a  perfunctory  way  without  the  display  of  any  inter- 
est. The  morbid  state  of  the  emotions,  however,  soon 
reacts  on  the  mind  in  such  a  way  that  the  reasoning  proc- 
esses are  interfered  with,  and  the  judgment  is  no  longer 
that  of  a  sane  person  :  emotional  depression  gives  place  to 
morbid  apprehensions,  and  an  indefinite  feeling  of  melan- 
choly to  dread  of  impending  ruin  in  this  world  or  in  the 
future  state.  Delusions  occur  at  this  stage.  Among  the 
commoner  delusions  in  the  early  stages  of  insanity  is  the 
conviction  that  some  one  —  generally  a  member  of  the  pa- 
tient's family  —  has  commissioned  the  police  or  a  private 
individual  to  act  as  a  spy  on  the  person  laboring  under  the 
delusion ;  that  there  is  a  conspiracy  to  ruin  him,  or  to  deprive 
him  of  his  rights  ;  that  attempts  are  being  made  to  poison 
him.  The  last-named  delusion  frequently  causes  those  who 
are  afflicted  with  it  to  arm  themselves  with  a  number  of 
bottles  of  medicine  or  parcels  of  food,  and  to  seek  the 
advice  of  a  chemist,  requesting  him  to  analyze  the  samples 
for  various  poisons.  It  is  rather  curious  that  suspicion  is  not 
always  directed  against  those  who  might  be  reasonably 
27 


322  MEDICAL   JURISPRUDENCE. 

suspected  of  criminal  motives,  —  such  as  the  members  of  the 
family  who  would  be  benefited  by  the  death  of  the  deluded 
person, — but  druggists  and  other  shop-keepers  who  are 
almost  strangers  to  him  are  often  the  alleged  secret  assas- 
sins ;  sometimes  the  allegation  of  conspiring  is  made  to 
account  for  this  inconsistency." 

Lucid  Interval.  —  In  a  legal  sense,  this  term  means  a 
temporary  intermission  of  the  insanity,  during  which  the 
reasoning  power  is  recovered.  It  differs  from  a  mere 
remission  of  the  symptoms,  such  as  is  seen  in  some  cases 
of  violent  mania.  During  such  an  interval  the  law  recog- 
nizes the  power  of  the  individual  to  make  a  will,  to  sign  a 
contract,  or  exercise  his  civil  rights.  He  is  also  held  re- 
sponsible for  crimes  committed  during  such  a  period.  The 
duration  of  these  intervals  is  uncertain,  varying  from  a 
few  minutes  to  weeks  or  months.  If  the  interval  is  very 
short,  the  fact  of  its  alleged  existence  is  always  the  more 
questionable. 

Lucid  intervals  are  most  common  in  mania ;  they  also 
occasionally  occur  in  dementia,  when  not  chronic.  They 
are  never  met  with  in'  idiocy  and  imbecility. 

In  order  to  establish  the  fact  of  the  existence  of  a  lucid 
interval,  the  burden  of  proof  rests  upon  the  plaintiff  in  a 
suit  in  which  he  desires  to  prove  the  validity  of  a  contract 
made  by  the  lunatic  during  such  interval. 

Varieties  and  Classification  of  Insanity.  —  Much  dif- 
ference exists  among  the  authorities  in  this  respect ;  the 
following  will  serve  the  purpose  of  the  work  probably  as 
well  as  any  system  : 


INSANITY.  323 

1.  Idiocy. 

2.  Imbecility. 

3.  Mania. 

4.  Melancholia. 

5.  Monomania. 

6.  General  Paralysis  of  Insane. 

7.  Dementia. 

8.  Certain  forms  of  mania  having  distinct  etiological  re- 
lations. 

Idiocy  is  distinguished  from  all  other  forms  of  mental 
disorder  by  being  congenital ;  and  this  condition  is  mani- 
fested by  imperfect  development  of  both  body  and  mind. 
The  idiot,  from  an  original  defective  structure  of  the  brain, 
is  able  to  acquire  only  a  limited  degree  of  intellectual 
power.  His  instincts,  habits,  and  appetites  are  largely 
animal.  Often  there  is  no  sign  of  recognition,  nor  indica- 
tion of  memory,  in  which  respect  he  is  below  many  animals. 
There  are  some  cases  of  idiocy,  however,  in  which  the  want 
of  cerebral  development  is  not  so  great,  and  some  intelli- 
gence is  manifested,  with  a  partial  development  of  some  few 
of  the  faculties.  Such  idiots  are  docile  and  tractable  ;  they 
are  capable  of  being  taught  many  things  by  careful  and 
judicious  training,  even  to  talk  and  read ;  and  thus  of  being 
materially  improved. 

Among  the  causes  of  idiocy  are  intemperance  in  the 
parents,  and  marriages  of  consanguinity.  Syphilis  has  also 
been  supposed  to  predispose  to  idiocy  in  the  offspring. 
Idiots  are  generally  short-lived,  their  age  rarely  extending 
beyond  thirty  years. 

Physical  Peculiarities  of  Idiots. — These  are  manifested  in 
smallness  of  the  head,  in  the  majority;   thickness  of  the 


324  MEDICAL    JURISPRUDENCE. 

lips,  which  are  often  fissured,  particularly  the  lower  one  ; 
enlargement  of  the  tongue,  salivary  glands,  and  tonsils  ; 
vaulting  of  the  hard  palate  ;  irregularity  of  the  teeth,  with 
tendency  to  early  decay;  deficiency  of  the  lobules  of  the 
ears ;  defects  of  vision,  such  as  myopia  and  congenital 
cataract ;  weakness  and  clubbed  appearance  of  the  fingers 
and  thumbs,  and  want  of  power  over  the  sphincters.  In 
some  idiots  the  head  is  preternaturally  large,  especially  in 
congenital  hydrocephalus. 

An  autopsy  will  generally  disclose  a  deficiency  of  gray 
matter  (from  a  defective  size  of  the  brain)  and  a  want  of 
proper  development  of  the  convolutions ;  sometimes  an 
absence  of  the  entire  cerebellum,  of  the  pineal  gland,  of 
part  of  the  fornix,  of  the  olivary  bodies,  thalamus,  and 
corpus  striatum ;  and  an  absence,  or  rudimentary  state,  of 
the  corpus  callosum  and  soft  commissures.  Deaf-dumb- 
ness is  common.  Some  are  born  deaf,  dumb,  and  blind  ; 
yet,  in  the  case  of  Laura  Bridgman,  the  deprivation  of  all 
these  faculties  did  not  prevent  acquiring  a  remarkable 
degree  of  intelligence,  under  careful  training. 

While  the  higher  faculties  are  wanting,  there  often  exists 
a  marked  development  of  the  lower  ones,  such  as  the  love  of 
money,  sexual  feelings,  gluttony,  and  filthy  habits,  together 
with  a  slow  and  tottering  gait. 

Cretinism. — A  peculiar  form  of  idiocy,  at  one  time  sup- 
posed to  be  endemic  in  certain  mountainous  countries,  as 
Switzerland,  Savoy,  etc.  It  is  chiefly  marked  by  an  enor- 
mous development  of  the  thyroid  gland,  which,  however,  in 
some  cases,  may  be  altogether  absent.  The  mouth  is  large, 
and  the  hands  and  fingers  misshapen.  The  eyes  are  squint- 
ing, the  face  pale  and  sallow,  and  the  speech  thick  and 


INSANITY.  325 

muffled.  The  intelligence  is  about  that  of  idiocy.  The 
smaller  goiters  found  in  other  countries  do  not  necessarily 
impair  the  intellect. 

Imbecility.  — This  differs  from  idiocy  chiefly  from  the  fact 
of  its  being  acquired  after  birth  ;  the  bodily  defects  are  also 
asymmetrical,  and  the  intellectual  manifestations  are  rather 
different,  being  exhibited  in  low,  mischievous  cunning,  bad 
temper,  silliness,  and  stupidity,  and  may  often  be  accom- 
panied with  epilepsy  or  paralysis  (Hamilton).  The  power 
of  speech  is  less  frequently  absent  than  in  idiocy. 

The  precise  boundary  between  idiocy  and  imbecility 
cannot  be  defined,  so  far  as  intellectual  manifestations  are 
concerned,  unless  we  make  the  distinction  to  consist  in  the 
congenital  character  of  the  former.  Neither  of  them  is 
likely  to  be  confounded  with  mania  and  monomania,  since 
in  the  former  there  is  a  total  absence  of  ideas  and  of  the 
power  of  thought,  both  of  which  are  present  in  maniacs  and 
monomaniacs,  although  perverted  and  irregular.  More- 
over, idiocy  and  imbecility  are  destitute  of  hallucinations, 
which  are  characteristic  of  mania  and  monomania.  Their 
resemblance  to  confirmed  dementia  is  much  stronger. 

Legal  Relations  of  Idiocy  and  Imbecility. — When  these 
mental  conditions  are  positive  and  distinct,  there  can  be 
no  question  of  their  entire  irresponsibility,  both  civil  and 
criminal. 

Mania.  — This  variety  of  mental  disorder  is  characterized 
by  a  general  perversion  of  the  mental  faculties,  accompanied 
by  more  or  less  excitement,  sometimes  amounting  to  fury. 
The  reasoning  faculty  is  not  absolutely  lost,  but  disturbed 
and  confused  ;  ideas  flow  through  the  mind  without  order 
or  connection ;  they  are  evolved  from  the  brain  in  chaotic 


326  MEDICAL   JURISPRUDENCE. 

exuberance,  following  one  another  with  inconceivable 
rapidity  and  entirely  without  control.  With  the  maniac 
everything  is  active  —  the  emotions,  the  memory,  the 
imagination,  the  speech,  and  the  features.  "  He  mingles 
abusive,  obscene,  and  blasphemous  words  with  the  most 
pious  reflections."  His  movements  are  brusque,  disorderly, 
and  extravagant ;  he  dances,  runs,  leaps,  tears  off  his 
clothes,  breaks  things,  and  exhibits  enormous  strength. 
The  voice  becomes  hoarse,  the  skin  is  dry  and  hot ;  the  eye 
has  a  peculiar,  wild,  brilliant  expression,  with  often  a  fixed 
stare.  The  pulse  is  rapid,  and  respiration  and  temperature 
above  normal.  They  generally  eat  enormously  and  vora- 
ciously. Urine  and  feces  are  often  passed  involuntarily ; 
the  bowels  are  apt  to  be  torpid  ;  perspiration  abundant  and 
sour.  There  is  frequently  sexual  excitement,  particularly 
in  females,  and  when  this  is  the  chief  feature  of  the  mental 
disturbance,  it  is  called  satyriasis  in  males,  and  nympho- 
mania in  females. 

Along  with  the  intellectual,  the  moral  faculties  become 
more  or  less  perverted,  and  the  patient's  social  and  domestic 
relations  are  greatly  altered,  jealousy,  suspicion,  and  hatred 
being  evinced  toward  those  whom  he  had  formerly  loved 
with  the  deepest  affection.  He  is  haunted  by  the  wildest 
delusions,  under  whose  influence  he  may  act  in  the  most 
dangerous  and  ungovernable  manner. 
» 

Melancholia  differs  materially  from  the  first  (mania  pro- 
per), in  being  connected  with  depression  instead  of  excite- 
ment. Delusions  may  not  always  be  present,  or,  at  least, 
not  be  observable ;  the  sufferer  is  gloomy  and  the  prey  to 
unhappy  and  desponding  thoughts,  which  often  lead  to 
suicide  ;  he  is  sleepless,  refuses  food,  often  under  the  delu- 


INSANITY.  327 

sion  that  it  is  poisoned.  The  delusions  and  hallucinations 
may  assume  an  infinite  variety  of  shapes  ;  they  are  often  of 
a  religious  character,  and  very  frequently  connected  with 
an  idea  of  undergoing  persecution.  This  latter  delusion  is 
veiy  common,  and  under  its  influence  the  sufferer  may 
resort  to  homicidal  violence  toward  those  whom  he  may 
imagine  are  his  enemies.  He  should,  therefore,  be  con- 
stantly watched. 

This  form  of  mental  disorder  rarely  exists  in  an  uncom- 
plicated form  ;  it  is  apt  to  be  alternated  with  fits  of  excite- 
ment (mania).  The  physical  characters  of  melancholia  are 
quite  characteristic.  "  The  patient,  if  a  female,  is  dirty  in 
her  habits,  soiling  her  clothes,  and  paying  little  attention  to 
her  appearance.  With  disordered  hair  and  averted  eyes 
the  melancholic  sits  by  herself,  lost  in  her  own  reflections, 
although  there  are  some  who  are  communicative  and  loqua- 
cious." "  The  face  is  pinched  and  wan,  and  unnaturally 
pale  ;  the  eyelids  droop  and  the  facial  folds  are  dependent ; 
the  lips  are  bloodless  ;  the  pupils  are  dilated,  and  every- 
thing indicates  inaction  ;  the  hands  are  livid  and  hang  idly, 
and  the  maintenance  of  a  fixed  position,  sometimes  for 
hours  at  a  time,  is  characteristic  of  the  intellectual  torpor." 
(Hamilton.) 

Monomania.  — This  form  of  insanity  has  received  other 
names,  such  as  paranoia  and  primary  delusional  insanity. 
"  The  patient,  in  the  simplest  form  of  the  disease,  becomes 
possessed  of  some  single  notion,  which  is  alike  contradic- 
tory to  common  sense  and  to  his  own  experience  "  (Hus- 
band). Sometimes  it  may  have  reference  to  some  fancied 
bodily  disease,  as  where  he  believes  he  has  a  snake  or  a 
lizard  in  his  stomach ;    or,  as  in  the  case  of  the  woman 


328  MEDICAL   JURISPRUDENCE. 

mentioned  by  Esquirol,  who  had  hydatids  in  the  uterus, 
and  who  believed  that  she  was  pregnant  by  the  devil. 

Moral  Mania.  —  The  title  "moral  mania"  has  been  as- 
signed, by  Dr.  Ray  and  others,  to  those  cases  of  mental 
disturbance  which,  in  the  language  of  Prichard,  "  consist  in 
a  morbid  perversion  of  the  natural  feelings,  affections,  incli- 
nations, temper,  habits  and  moral  dispositions,  without  any 
notable  lesion  of  the  intellect  or  knowing  or  reasoning 
faculties,  and  particularly  without  any  maniacal  hallucina- 
tions." There  is  considerable  diversity  of  opinion  among 
writers  as  to  the  existence  of  moral  insanity  as  a  distinct 
variety  of  mental  disorder.  Some  deny  its  existence  as 
such,  and  assert  that  there  can  be  no  derangement  of  mind, 
without  the  intellect  being  affected.  Such  authorities  are 
disposed  to  regard  the  merely  moral  perversions  above 
alluded  to  as  evidences  of  a  moral  obliquity,  showing  an 
excessive  perverseness  of  character,  rather  than  a  derange- 
ment of  mind.  What  has  been  termed  emotional  insanity, 
in  modern  times,  partakes  of  this  character.  It  must  cer- 
tainly be  rare  that  any  person  becomes  suddenly  affected 
with  an  insane  homicidal  impulse ;  and  unless  it  can  be 
clearly  shown  that  the  culprit  had  exhibited  previous  un- 
equivocal signs  of  insanity,  or  had  a  strong  heredity  thereto, 
such  a  plea  as  that  of  emotional  insanity  is  not  likely  to  be 
allowed.  Unquestionably,  the  moral  faculties  are  perverted 
in  insanity,  often,  to  appearance,  more  decidedly  than 
those  of  the  intellect ;  but  it  is  rare,  if  ever,  that  they  are 
exclusively  deranged.  The  manifestations  of  a  disordered 
mind  may  assume  an  almost  endless  variety  of  forms, 
doubtless  dependent  somewhat  on  the  natural  disposition 
or  mental  conformation  of  the  patient.  In  some,  the  intel- 
lectual pei'versions  will  be  more  pronounced ;    in  others, 


INSANITY.  329 

disturbances  of  the  moral  faculties,  affections,  and  sentiments 
are  more  obvious.  Hence,  it  would  be  highly  dangerous 
to  pronounce  a  person  insane  unless  there  was  some  evi- 
dence of  intellectual  disturbance  along  with  exhibitions  of 
a  depraved  moral  nature.  It  would  be  offering  an  excuse, 
or  at  least  a  palliation,  for  all  sorts  of  moral  obliquity. 

The  law  does  not  recognize  moral  insanity  as  an  indepen- 
dent state  ;  "  hence,  however  perverted  the  affections,  moral 
feelings,  or  sentiments  may  be,  the  medical  jurist  must 
always  look  for  some  indications  of  disturbed  reason" 
(Taylor).  Although,  according  to  Dr.  Prichard,  there  are 
two  forms  of  insanity  (moral  and  intellectual),  in  law  there 
is  but  one  —  that  which  affects  the  mind. 

The  term  "  partial  moral  mania "  has  been  assigned  to 
such  cases  of  mental  action  as  are  manifested  by  certain 
forms  of  moral  perversion,  when  only  one  or  two  phases 
of  the  moral  powers  are  deranged.  Different  names  are 
employed  to  designate  these. 

Kleptomania,  or  a  propensity  to  steal,  as  shown  in  persons 
of  excellent  moral  character  in  other  respects,  and  whose 
easy,  and  even  affluent,  circumstances  preclude  the  idea  of 
want  as  a  motive  inciting  to  the  crime.  Some  kleptomaniacs 
appear  to  be  sensible  of  their  fault,  and  are  ready  to  confess 
and  lament  their  unhappy  propensity.  There  are,  however, 
cases  of  so-called  kleptomania  in  which  there  is  a  perfect 
consciousness  of  the  act,  and  of  its  illegality ;  where  the 
article  stolen,  although  of  trifling  value,  was  yet  of  some  use 
to  the  person  ;  where  art  and  precaution  were  employed  in 
the  theft ;  and  v/here  there  was,  subsequently,  a  denial  of 
the  act,  or  some  evasive  excuse.  Of  such  persons  it  might 
more  properly  be  said  that  their  organ  of  secretiveness  was 
28 


330  MEDICAL   JURISPRUDENCE. 

very  largely  developed.  In  a  trial  of  a  case  of  this  kind  it 
must  be  shown  that  the  prisoner  was  incapable  of  under- 
standing that  the  particular  act  in  question  was  a  wrong 
one.  Otherwise,  the  whole  class  of  thieves  might  equally 
urge  the  plea  of  insanity  as  a  palliation  of  their  crimes. 

Pyromania. — A  propensity  or  impulse  to  set  fire  to 
everything  —  houses,  barns,  churches,  etc.,  without  any 
motive.  Hamilton  speaks  of  it  as  being  often  connected 
with  a  variety  of  epileptic  insanity.  It  is  rare  to  find  this 
moral  perversion  disconnected  with  other  morbid  impulses, 
especially  homicidal  or  suicidal.  A  well-known  historical 
instance  of  pyromania  is  that  of  Martin,  who  attempted  to 
set  fire  to  York  cathedral.  Many  cases  of  so-called  pyro- 
mania will  be  found,  on  investigation,  to  originate  in  per- 
sonal grudge  or  revenge. 

Dipsomania  —  Responsibility  of  Drunkards.  —  By  this  term 
is  understood  that  form  of  insanity  which  manifests  itself  in 
a  craving  for  alcohol  —  a  craze  for  drink.  It  differs  from 
the  habitual  desire  for  liquor  of  the  ordinary  dram-drinker 
in  the  fact  that  there  are  distinct  remissions  of  the  disease, 
during  which  there  is  not  the  slightest  longing  for  drink 
experienced,  but  rather  a  loathing  for  it ;  but  when  this 
interval  has  passed  away,  the  inordinate  desire  returns,  and 
the  unhappy  victim  will  plunge  into  violent  excesses,  often 
frequenting  the  lowest  taverns,  and  spending  days  and 
nights  in  literally  saturating  his  system  by  drinking  enor- 
mous quantities  of  brandy  and  other  spirits.  During  these 
excesses  the  person  shuns  all  society,  and  remains  often 
secluded  for  many  days  and  even  weeks. 

As  regards  the  responsibility  of  drunkards,  opinions 
differ.  There  can  be  no  question  that  where  the  mind  has 
become  completely  weakened  by  habitual  drunkenness  the 


INSANITY.  331 

law  would  infer  irresponsibility,  unless  it  was  clear  that 
at  the  time  of  the  act  the  person  was  fully  aware  of  its 
nature  and  criminality.  In  a  case  of  complete  inebriety, 
where  there  is  entire  loss  of  consciousness,  the  individual 
is  incapable  of  giving  a  valid  consent ;  consequently,  any 
deed  or  contract  then  executed  would  be  invaHd  ;  but  if  the 
intoxication  be  only  partial,  so  that  the  party  knew  what 
he  was  about,  the  act  or  deed  would  be  held  to  be  valid. 
A  confession  made  by  a  partially  drunken  man  is  legally  ad- 
missible as  evidence  against  him,  provided  it  is  corroborated 
by  circumstances. 

The  criminal  responsibility  of  drunkards  is  more  rigidly 
regarded  by  the  law  than  their  civil  responsibility.  Thus, 
murder  committed  by  a  drunken  man  is  not  extenuated 
because  his  brain  may  have  been  crazed  by  drink,  if  volun- 
tarily induced  on  his  part.  If  it  can  be  shown  that  the 
drunkenness  has  produced  a  disease  of  the  mind  to  such  an 
extent  as  to  have  deprived  him  of  a  consciousness  of  the 
illegality  of  the  act,  then  his  irresponsibility  must  be  ad- 
mitted. A  mitigating  circumstance  in  such  a  case  would 
be,  if  it  could  be  shown,  that  the  prisoner  was  not  actuated 
by  malice  or  grudge  against  the  deceased,  but  had  killed 
him  while  under  the  effects  of  alcohoHsm. 

Although  drunkenness  does  not  excuse  crime  in  the  eye 
of  the  law,  yet  the  insanity  which  may  result  from  habitual 
drunkenness  does  certainly  confer  irresponsibility.  So,  like- 
wise, it  has  been  decided  in  some  cases  of  deliriiivi  tremens, 
when  the  brain  is  temporarily  diseased,  so  as  to  render  the 
individual  incapable  of  reason. 

Homicidal  Monomania.  —  In  this  form  of  madness  the 
propensity  to  homicide  is  very  great.  There  may,  or  may 
not,  accompany  it  some  intellectual   aberrations ;  but  the 


332  MEDICAL    JURISPRUDENCE. 

characteristic  feature  is  an  uncontrollable  impulse  to  take 
life,  —  often  of  those  dearest  to  the  unhappy  victim, — actu- 
ated by  some  delusion  which  has,  perhaps,  been  preying 
upon  his  mind  for  months  before,  but  only  now  suddenly 
breaking  out. ,  Many  striking  cases  of  this  form  of  insanity 
are  recorded  in  the  books,  all,  however,  evincing  other 
unmistakable  signs  of  intellectual  disturbance. 

The  following  suggestions,  taken  chiefly  from  Husband, 
may  aid  in  forming  a  diagnosis  of  the  existence  or  non- 
existence of  this,  form  of  insanity:  — 

1.  Inquire -into  the  previous  histoiy  of  the  person:  Was 
he  morose,  melancholic,  apprehensive  of  impending  evil, 
etc.  ?  Had  he  previously  received  a  fall  upon  his  head,  or 
been  otherwise  injured?  Such  a  homicidal  propensity 
rarely,  if  ever,  manifests  itself  suddenly  for  the  first  time, 
like  a  flash  of  lightning  out  of  a  clear  sky  ;  it  is  almost  in- 
variably preceded  by  other  symptoms  of  mental  disturbance, 
and  usually  of  a  melancholic  character. 

2.  Ascertain  the  presence  or  absence  of  a  motive  —  a  most 
important  factor  in  the  responsibility  of  the  accused.  Often 
the  real  motive  may  be  so  deeply  hidden  in  the  breast  of 
the  culprit  as  to  be  completely  concealed  from  the  view  of 
others,  and  scarcely  recognized  by  himself. 

3.  A  number  of  victims  may  be  sacrificed  at  one  time  by 
the  madman  ;  the  ordinary  murderer,  on  the  other  hand, 
seldom  sheds  more  blood  than  is  necessary  for  his  success. 

4.  The  conduct  of  the  accused  before  and  after  the  crime  ; 
the  insane  man  usually  makes  no  attempt  to  escape,  but 
rather  glories  in  the  bloody  deed,  assigning  his  conduct  to  a 
divine  or  spiritual  impulse. 

5.  The  character  of  the  victims.  Not  infrequently  the 
madman  destroys  those  who  were  the  dearest  to  him  while 


INSANITY.  333 

he  was  sane,  and  for  whose  destruction  he  could  hav^e  had 
no  conceivable  motive. 

Suicidal  Moiiomania.  —  This  form  of  insanity  displays 
itself  by  the  prominent  idea  of  self-destruction.  Consider- 
able diversity  of  opinion  exists  upon  the  question  whether 
suicide  is  always  to  be  regarded  as  evidence  of  insanity. 
Probably  in  the  majority  of  cases  suicide  is  to  be  directly 
ascribed  to  insanity ;  but  there  are  numerous  instances 
where  the  act  of  self-destruction  is  deliberately  perpetrated 
with  a  distinct  motive  and  for  a  purpose.  Suicide  was  at 
one  period  of  the  world's  history  regarded  as  rather  a 
praiseworthy  act  on  the  part  of  persons  wearied  of  life. 
Philosophers,  poets,  statesmen,  generals  and  moralists 
believed  in  it  and  practiced  it.  Even  at  the  present  date 
it  exists  under  national  sanction  in  India  and  Japan.  In 
our  own  times  and  country  we  have  almost  daily  examples 
of  deliberate  suicides  for  whom  the  plea  of  insanity  could 
never  be  urged.  Moreover,  the  laws  of  most  modern  civil- 
ized countries  regard  suicide  as  a  crime,  which  they  could 
not  consistently  do  if  it  was  merely  the  manifestation  of 
disease  (insanity).  Consequently,  the  argument  is  unan- 
swerable, that  many  cases  of  suicide  are  the  result  of  a 
perfectly  sane  and  deliberate  purpose  acting  upon  the  un- 
happy victim,  and  leading  him  to  prefer  death  by  his 
own  hand  rather  than  endure  the  miseries  of  his  present 
existence. 

The  almost  uniform  verdict  of  coroners'  juries  in  cases  of 
suicide  —  "death  by  his  own  hands,  while  laboring  under 
temporary  insanity" — would  seem  to  give  some  weight  to 
the  popular  idea  that  suicide  was  always  the  result  of  in- 
sanity;   but  this  is  doubtless  to  be  ascribed  to  a  natural 


334  MEDICAL    JURISPRUDENCE, 

desire  on  their  part  to  soften  down  as  much  as  possible  the 
terrible  nature  of  the  death,  in  consideration  of  the  feelings 
of  the  surviving  relatives. 

In  cases  of  true  suicidal  mania  it  may  happen  that  a 
latent  delusion,  often  assuming  the  form  of  hallucination, 
may  have  been  haunting  the  victim  for  months  before  the 
perpetration  of  the  fatal  act;  while  in  other  instances,  the 
impulse  is  sudden  and  apparently  unpremeditated.  Even 
in  the  latter  case  it  will  usually  be  found,  on  careful  exam- 
ination into  the  previous  history  of  the  person,  that  there 
were  some  former  manifestations  of  mental  disorder.  The 
case  of  the  barber  (mentioned  by  Sir  C.  Bell),  who  cut  his 
own  throat  immediately  after  hearing  a  surgeon,  whom  he 
was  shaving,  describe  the  proper  mode  of  performing  that 
deed,  illustrates  the  suddenness  of  the  impulse  in  some 
cases  of  suicide ;  but  it  is  possible  that  the  mind  of  this 
man  had  been  frequently  dwelling  upon  this  subject  pre- 
vious to  the  commission  of  the  deed. 

It  is  well  understood  that  the  law  does  not  regard  suicide 
as  evidence  of  insanity,  so  that  the  validity  of  a  will  executed 
by  one  who  subsequently  takes  his  own  life  is  not  affected 
thereby.  . 

The  relation  of  suicide  to  life  insurance  is  one  of  great 
practical  importance  from  a  medico-legal  point  of  view.  The 
policies  of  most  life  insurance  companies,  until  very  recently, 
contained  a  clause  to  the  effect  that  the  policy  became  void 
if  the  insurer  should  "  die  by  his  own  hand" — making  no 
distinction  whatever  between  a  felo-de-se  committed  delib- 
erately and  intelligently  and  a  suicide  resulting  either  from 
the  acute  delirium  of  fever  or  from  a  more  chronic  form  of 
mental  disease.  Most  assuredly,  if  regarded  from  an  equit- 
able standpoint,  the  policy  should  not  be  forfeited  under 


INSANITY.  335 

these  latter  circumstances,  any  more  than  if  the  death  of 
the  insured  had  been  caused  by  apoplexy  or  by  any 
casualty.  How  absurd  it  would  seem  for  any  company  to 
make  its  insured  responsible  for  that  diseased  mental  con- 
dition which  may  culminate  in  an  insane  act  of  self-destruc- 
tion, any  more  than  for  an  attack  of  phrenitis,  arachnitis,  or 
typhoid  fever,  in  all  of  which  there  may  be  acute  delirium, 
driving  its  victim  to  an  act  of  suicide  !  The  line  should  be 
sharply  drawn,  in  cases  of  life  insurance,  between  intelligent 
suicides  and  insane  suicides — the  former  being  held  respon- 
sible for  the  act  of  self-destruction,  and,  therefore,  vitiating 
their  policy  ;  while  the  latter  are  to  be  regarded  as  irrespon- 
sible, and  consequently  not  vitiating  their  policies.  Any 
other  ruling  seems  unjust.  In  point  of  fact,  however,  nearly 
all  the  life  companies  have  dropped  both  suicide  and  intem- 
perance as  disqualifying  causes  for  non-payment. 

Just  here  we  should  not  lose  sight  of  the  very  im- 
portant distinction  between  doing  an  act  intentionally  and 
doing  it  intelligently.  The  insane  person,  equally  with  the 
man  of  sound  intellect,  commits  the  suicidal  act  intention- 
ally, i.  e.,  he  cuts  his  throat,  shoots  himself  with  a  pistol, 
drowns,  or  hangs  himself,  intending  to  take  his  own  life 
thereby ;  but  there  is  this  all-important  distinction  between 
the  two  :  the  sane  man  does  the  deed  intelligently  as  well 
as  intentionally,  fully  aware  at  the  time  of  the  illegality  of 
the  act  and  of  all  of  its  consequences  both  here  and  here- 
after. The  insane  man,  on  the  contrary,  commits  the  act 
with  his  mind  not  in  its  normal  equipose,  but  swayed  by  an 
insane  delusion. 

There  is  a  form  of  suicide  which  might  give  rise  to  con- 
siderable casuistry  in  cases  of  life  insurance  :  in  which  a  per- 
son in  the  habit  of  using  powerful  drugs,  such  as  laudanum 


336  MEDICAL   JURISPRUDENCE. 

or  chloral,  for  medicinal  purposes,  takes  a  very  large  dose 
while  in  a  state  of  intoxication,  and  dies.  In  such  a  case 
the  act  of  self-destruction,  not  being  intentional,  could 
hardly  be  deemed  felonious,  and  therefore  not  coming 
within  the  statute.  But,  on  the  other  hand,  as  drunkenness 
is  not  a  legal  excuse  for  homicide,  it  might  be  made  to 
affect  the  question  of  suicide  also,  which  thus,  under  the 
circumstances,  might  be  held  as  felonious  killing. 

As  remarked  by  Taylor,  if  suicide  is  in  all  cases  the 
result  of  insanity,  the  act  ought  to  be  more  frequent  among 
the  insane.  Experience  does  not  favor  this  idea.  The 
report  of  the  British  Commissioners  of  Lunacy  for  1850 
shows  that  out  of  15,079  persons  that  year  confined  as 
lunatics,  there  occurred  only  eight  suicides. 

The  suicidal  tendency,  or  impulse,  appears  at  times  to 
assume  an  almost  epidemic  tendency  in  a  community.  Imi- 
tation has,  undoubtedly,  much  to  do  with  this,  especially 
when  the  mode  of  self-destruction  adopted  and  the  attend- 
ing circumstances  were  of  a  peculiarly  sensational  character. 
Thus,  a  second  and  a  third  suicide  took  place  in  rapid  suc- 
cession, soon  after  the  first,  by  jumping  from  the  top  of  the 
monument  in  London.  The  same  thing  occurred  in  Paris 
from  the  Napoleon  monument.  Dr.  Forbes  Winslow  states 
that  "  some  years  ago  a  man  hung  himself  on  the  threshold 
of  one  of  the  doors  of  the  Hotel  des  Invalides.  No  suicide 
had  occurred  in  the  establishment  for  two  years  previously ; 
but  in  the  succeeding  fortnight  five  persons  hung  them- 
selves on  the  same  cross-bar,  and  the  governor  was  obliged 
to  shut  up  the  passage."  The  tendency  to  suicide  seems 
to  be  hereditary  in  certain  cases,  extending  through  several 
generations.  But  in  all  these  instances  there  were  other 
unmistakable  evidences  of  a  deranged  mind. 


INSANITY.  337 

General  Paralysis  of  the  Insane.  —  This  affection, 
known  also  as  "paretic  dementia,"  is  a  disease  of  the  brain, 
characterized  by  both  mental  and  motor  symptoms.  Its 
approach  is  gradual  and  insidious.  It  often  follows  alco- 
holism and  syphilis,  and  likewise  mental  overwork  of  any 
kind  —  any  cause  that  occasions  a  continuous  overstrain, 
up  to  the  point  of  exhaustion,  upon  that  portion  of  the 
cerebral  mass  in  which  mentalization  especially  resides. 
Clouston  shows  this  function  to  be  especially  located  in  the 
gray  substance  of  the  convolutions.  Its  outer  layer  or  rind 
is  most  delicately  constituted,  has  far  more  blood  and  more 
minute  cells  than  any  other  portion  of  the  brain,  and  on 
the  whole  may  be  regarded  as  the  most  important  factor 
in  mentalization,  being,  in  fact,  the  mind-tissue.  General 
paralysis  is  a  disease  of  this  outer  layer  of  the  cerebral 
convolutions  —  of  the  mind-tissue,  in  fact.  "  It  is  essentially 
a  death  of  that  tissue.  It  is  equivalent  to  a  premature  and 
sudden  senile  condition  —  senility  being  the  slow  physi- 
ological process  of  ending,  general  paralysis  the  quick 
pathological  one.  The  causes  of  it  are  causes  that  have 
exhausted  the  trophic  energy  by  over-stimulation." 

It  may  begin  with  scarcely  perceptible  alterations  in 
manner,  fretfulness,  irritability,  and  carelessness  in  habits, 
which  are  soon  succeeded  by  ridiculous  boastings  of 
possessions  and  personal  abilities  (delusions  of  grandeur). 
These  delusions  assume  various  forms  and  expressions ; 
sometimes  it  is  enormous  wealth  of  money  and  jewels  ; 
again,  it  is  herculean  strength  of  body,  or  wonderful  mental 
capacity ;  again,  it  may  take  the  form  of  extraordinary 
sexual  capacity.  Along  with  these  there  is  the  most  fool- 
ish extravagance,  purchasing  the  most  useless  articles  and 
throwing  away  money  with    the   most   reckless   prodigal- 


338  MEDICAL    JURISPRUDENCE. 

ity.  "  At  this  time  there  will  be  noticed  a  loss  of  muscular 
power ;  at  first,  the  tongue  will  tremble  when  protruded  ; 
then  the  lips  become  tremulous,  and  the  corners  of  the 
mouth  uneven ;  the  speech  is  clumsy,  and  there  is  great 
difficulty  in  pronouncing  the  labial  and  lingual  consonants  " 
(Hamilton).  The  pupils  are  apt  to  be  unequally  dilated,  or 
they  may  both  be  much  contracted. 

As  the  disease  advances,  the  gait  becomes  unsteady  and 
trembling.  Vision  is  also  impaired,  as  are  also  the  other 
senses.  Fits  of  violence  often  alternate  with  a  melancholic 
condition,  and  epileptic  and  hemiplegic  attacks  may  com- 
plicate the  case  toward  the  last ;  but,  as  has  been  already 
suggested,  these  may  be  indications  of  some  organic  dis- 
order which  occasionally  accompanies  the  disease. 

Among  the  frequent  accompaniments  of  this  form  of  in- 
sanity, Clouston  alludes  to  the  "insane  ear"  or  hematoma 
aiiris,  a  bloody,  gelatinous  swelling  of  the  ear,  usually  the 
result  of  a  blow  upon  that  organ,  although  sometimes  of 
spontaneous  origin.  Its  occurrence  is  always  an  unfavor- 
able prognosis  in  this  and  other  forms  of  insanity.  "  It  is 
connected  with  arterial  degeneration  in  the  branches  of  the 
carotid  artery.  The  contents  of  hematoina  auris  are  like 
the  extravasations  under  the  dura  mater  in  pachymeningitis 
lieuiorrhagica  interna,  a  disease  that  is  liable  to  occur  in 
precisely  the  same  class  of  persons." 

There  are  periods  of  remission  in  general  paresis,  during 
which  the  individual  appears  quite  sane.  These  may  last 
for  weeks  or  months.  During  these  intervals  the  question 
of  his  testamentary  capacity  may  be  raised,  which,  of  course, 
would  have  to  be  decided  according  to  the  actual  mental 
condition  of  the  patient.  If  under  an  extravagant  delusion 
extravagant  and  unjust  bequests  were  made,  these  should, 


INSANITY.  339 

undoubtedly,  be  set  aside,  as  being  the  offspring  of  a  de- 
ranged mind. 

The  prognosis  in  general  paresis  is  always  unfavorable ; 
the  disease  progresses  to  a  fatal  termination,  though  not 
always  rapidly. 

Dementia. — This  term  is  used  to  define  the  condition 
manifested  by  a  decay  of  the  mental  powers.  Commencing 
with  a  gradual  enfeeblement  of  the  mind,  it  may  terminate 
in  its  total  extinction.  It  differs  totally  from  mania  in  being 
attended  by  a  lack  of  ideas,  while  the  former  is  characterized 
by  an  exuberance  of  ideas,  although  these  are  confused 
and  incoherent.  Dementia  is  essentially  a  disease  of  depres- 
sion ;  mania,  one  of  excitement.  It  may  follow  acute  mania 
or  melancholia,  or  result  from  cerebral  organic  disease  or 
injury,  and  it  is  a  frequent  accompaniment  of  old  age  (senile 
dementia).  Its  most  striking  symptom  is  loss  of  memory, 
this  faculty  being  the  first  to  show  signs  of  decay.  This 
progressively  increases,  until  everything  seems  to  be  for- 
gotten by  the  patient,  even  what  he  has  seen,  or  heard,  or 
done  only  a  few  moments  before. 

The  general  mental  feebleness  is  further  manifested  by 
the  "  wavering  play  of  worn-out  emotions,  incoherence,  and 
half-formed  and  varying  delusions  "  (Hamilton).  The  delu- 
sions are  of  a  suspicious  character;  the  patient  is  unde- 
cided, childish,  and  silly  in  his  manners  ;  his  conversation  is 
incoherent ;  he  will  repeat  words  or  sentences  without  any 
meaning  ;  he  manifests  neither  partiality  nor  aversion  to 
former  friends  or  acquaintances  ;  he  moves  about  aimlessly 
for  hours,  or  may  I'emain  for  days  in  the  same  attitude. 
There  is  often  a  strong  disposition  exhibited  for  hoarding 
up  useless  articles,  as  if  they  were  of  great  value.     The 


340  MEDICAL   JURISPRUDENCE. 

countenance  is  generally  pale,  vacant,  and  without  expres- 
sion ;  the  look  vague  and  uncertain,  and  tears  are  often 
easily  shed,  from  the  slightest  cause. 

Secondary  dementia,  following  disease  of  the  brain,  is 
usually  gradual  in  its  approach,  the  decay  of  one  mental 
faculty  following  another,  and  accompanied,  also,  with  pro- 
gressive physical  weakness.  Such  cases  are  popularly 
known  as  "softening  of  the  brain"  ;  and  there  is  probably 
no  sadder  spectacle  to  witness  than  the  gradual  decay, 
through  disease,  of  both  mind  and  body,  in  one  whose 
former  brilliant  intellect  is  slowly  but  surely  giving  place  to 
the  fatuity  of  dementia. 

Dementia  is  thought  to  follow  mania  more  frequently 
than  melancholia  ;  and  although  it  may  seem  to  resemble 
the  latter  form  of  insanity  in  some  of  its  features,  it  differs 
from  it  in  exhibiting  less  coherence  of  ideas  and  less  ability 
to  keep  up  the  continuity  of  the  delusions. 

Senile  dementia  is  usually  marked  by  a  failure  of  both 
the  bodily  and  mental  powers  ;  it  exhibits  itself  by  loss  of 
memory  and  childishness.  The  person  is  cross  and  petu- 
lant, uncertain  in  action,  careless,  and  often  filthy  in  habits  ; 
wandering  about  aimlessly ;  often  foolishly  extravagant. 
The  patient  gradually  sinks  into  a  state  of  complete  fatuity, 
and  finally  dies  of  exhaustion. 

Puerperal  Insanity. — This  form  of  insanity  attacks 
women  at  a  period  varying  from  a  few  days  to  several 
weeks  after  delivery.  It  is  said  to  occur  most  frequently 
before  the  cessation  of  the  lochia.  It  is  usually  attended 
with  the  appearance  of  albumin  in  the  urine,  and  with  the 
interruption  or  suppression  of  the  milk  and  lochia.  The 
disorder  may  assume  any  form  of  mania,  from  the  grave  to 


( 


INSANITY.  341 

the  gay,  loquacious,  taciturn,  correct  or  foul  in  talk,  attended 
with  delusions  of  a  religious  character,  or  of  persecution. 
The  patient  is  apt  to  forget  recent  events  and  not  to  recog- 
nize persons.  Her  infant  is  either  disregarded,  or  becomes 
the  object  of  stealthy  destruction.  Instances  are  reported 
of  the  most  horrible  murders  of  their  offspring  by  mothers 
suffering  under  this  form  of  insanity.  Crimes  of  this  char- 
acter are  sometimes  committed  from  a  seemingly  sudden 
impulse  ;  whilst,  in  other  cases,  they  may  be  preceded  by 
torturing  doubt ;  and  the  very  sight  of  the  child  has 
aroused  the  almost  invincible  desire  to  murder  it.  Dr. 
Reese  notes  the  case  of  a  lady  who  had  completely  recov- 
ered from  her  first  confinement,  and  was  able  to  go  out. 
One  day,  several  weeks  after  the  birth  of  her  child,  she 
was  visiting  at  a  friend's  house,  when,  all  of  a  sudden,  she 
broke  out  into  the  most  violent  paroxysm  of  mania,  re- 
quiring bodily  restraint.  She  took  a  strong  dislike  both  to 
her  husband  and  child.  She  was  treated  in  different  asy- 
lums for  about  one  year,  when  she  completely  recovered, 
and  has  continued  well  ever  since,  having  also  given  birth 
to  another  child.  Women  suffering  from  puerperal  mania 
are  apt  to  commit  the  most  unexpected  crimes,  which,  at 
times,  may  be  misunderstood  by  juries,  and  may  be  mis- 
taken for  instances  of  intentional  infanticide.  Fortunately, 
however,  for  the  diagnosis  of  the  case,  the  crimes  are  bru- 
tally executed,  and  often  more  than  one  person  is  murdered, 
so  that  no  doubt  can  be  raised  as  to  the  real  condition  of 
the  patient. 

Somnambulism.  —  The  degree  of  responsibility  for  acts 
committed  in  sleep-walking,  or  somnambulism,  is  on  a  par 
with  those  committed  in  delirium  tremens — i.  e.,  there  is  no 


342  MEDICAL   JURISPRUDENCE. 

responsibility.  In  the  "unconscious  cerebration"  during 
sleep  it  is  presumed  that  intention  and  malice,  the  chief 
ingredients  of  crime,  are  wanting.  So,  also,  in  the  case  of  a 
person  half-awake,  suddenly  aroused  under  the  effect  of 
a  delusion  of  a  dream,  who  may  make  a  murderous  attack 
upon  his  wife  or  child,  supposing  he  is  defending  himself 
against  a  mortal  enemy,  no  criminal  responsibility  would 
be  imputed  to  him. 

Epileptic  Insanity.  —  The  majority  of  epileptics  sooner 
or  later  show  mental  deterioration.  According  to  Esquirol, 
out  of  339  epileptics  in  the  Salpetriere,  12  were  mono- 
maniacs ;  64  were  maniacal ;  34  were  furious  ;  145  were 
imbecile  or  demented  ;  8  were  idiotic  ;  50  were  habitually 
rational,  but  with  loss  of  memory,  exaltation  of  ideas,  some- 
times a  temporary  delirium,  and  a  tendency  to  dementia ; 
60  had  no  derangement  of  intellect,  but  were  very  irritable, 
irascible,  obstinate,  capricious  and  eccentric  (Ray).  An 
investigation  of  the  epileptic  wards  of  any  large  hospital 
will  give  similar  results.  An  epileptic  may  be  the  victim 
of  mania,  melancholia,  paranoia,  or  paretic  dementia.  Any 
form  of  insanity  may,  in  fact,  be  associated  with  epilepsy, 
but  a  certain  type  of  mental  disease  is  especially  regarded 
as  epileptic,  and  this  may  become  of  great  forensic  impor- 
tance. It  is  usually  studied  in  its  relation  to  the  motor 
paroxysm  or  fit,  and  from  this  point  of  view  can  be  subdi- 
vided into  I,  post-epileptic  insanity,  which  follows  the  con- 
vulsive attack  ;  2,  pre-epileptic  insanity,  which  precedes  the 
attack  ;  3,  the  psychical  substitute  of  the  attack  ;  4,  insan- 
ity occurring  in  the  interval  between  the  attacks. 

The  psychical  disturbances  which  occur  before,  after,  or 
as  the  equivalent  of  the  fit,  may  be  of  much  the  same 
character,  although  post-paroxysmal   outbreaks  are  most 


INSANITY.  343 

likely  to  be  maniacal.  Preceding  the  fit  the  epileptic 
frequently  shows  great  irritability,  moroseness  and  sus- 
picion. Mann  well  describes  a  typical  post-epileptic  condi- 
tion as  follows  :  "  After  a  fully-developed  seizure  the  patient 
usually  sleeps  profoundly  for  a  variable  period,  and  on 
awakening  is  in  his  former  condition,  except  that  he  feels 
sore  and  fatigued ;  in  some  cases  automatic  movements  are 
made  before  consciousness  returns.  A  man  may  have  a  fit 
in  the  street,  and  after  it  is  over  may  get  up  and  walk  a 
considerable  distance  without  any  perception  of  his  sur- 
roundings ;  when  he  comes  to  himself  he  finds  that  he  is 
in  a  neighborhood  quite  unknown  to  him.  Whilst  in  this 
condition  he  may  perform  a  variety  of  actions  of  a  purpo- 
sive nature  which  demand  complicated  movements  for  their 
execution.  The  actions  performed  are  determined  by  the 
influence  of  past  coordinations  on  the  motor  centers  acting 
in  the  absence  of  the  restraint  imposed  under  normal  condi- 
tions by  the  highest  controlling  centers,  the  latter  being  in 
a  state  of  passivity  from  exhaustion.  Many  of  these  actions 
present  all  the  appearance  of  volitional  movements,  and  yet 
the  individual,  both  at  the  time  and  afterward,  is  quite  un- 
conscious of  having  performed  them  ;  although  described 
as  automatic,  they  are  probably  initiated  by  a  slight  periph- 
eral stimulation,  or  by  one  of  internal  origin." 

The  remarkable  affection  of  memory  and  consciousness 
known  under  such  names  as  periodic  amnesia,  periodic 
asynesia,  double  consciousness,  and  alternate  consciousness, 
is  allied  to  epilepsy.  The  medico-legal  problems  which 
arise  in  connection  with  those  suffering  from  this  disorder 
belong  to  the  subject  of  epileptic  insanity.  Medical  litera- 
ture has  furnished  us  with  striking  illustrations  of  this 
disorder,  some   worthy   of    credence ;    and    novelists    and 


344  MEDICAL   JURISPRUDENCE. 

newspapers  have  woven  from  such  phenomena  stories  of 
thrilling  interest,  in  which,  however,  the  facts,  as  a  rule, 
are  far  from  keeping  pace  with  the  fiction.  Among  epi- 
leptics, periodic  amnesia,  or  an  allied  state,  is  observed  in  a 
variety  of  forms.  Instead  of  passing  into  a  maniacal  state, 
many  epileptics,  after  a  fit,  if  sleep  does  not  ensue,  become 
dazed,  confused,  or  somnambulistic.  Others  have  attacks 
which  have  been  described  as  epileptic  automatism,  con- 
cealed epilepsy,  or  masked  epilepsy,  in  which  are  performed 
unusual,  grotesque,  or  vicious  acts,  which  may  bring  the 
persons  within  the  purview  of  the  law.  Among  such  acts 
are  undressing  or  urinating  in  public.  It  will,  of  course, 
often  be  extremely  difficult  to  convince  authorities  that 
such  a  performance  is  not  criminal. 

In  some  cases  crimes  are  committed  by  those  who  are 
probably  epileptic,  or  at  least  sufferers  from  some  of  the 
epileptoid  affections  of  consciousness  and  memoiy,  but  who 
are  not  known  to  be  thus  afflicted.  A  remarkable  case  has 
been  reported  by  Yellowlees.  The  patient  had  a  clear 
history  of  somnambulism  and  night-walking  from  when  he 
was  a  mere  lad  until  the  time  when  he  committed  the  crime 
for  which  he  was  tried  for  his  life.  He  became  more  and 
more  subject  to  somnambulistic  seizures  as  he  grew  older, 
and  these  attacks  were  accompanied  with  great  terror  and 
with  the  appearance  of  visions  of  wild  beasts  and  other 
horrible  things.  Sometimes  he  would  tear  his  wife  and 
child  from  the  bed  while  fiercely  chasing  wild  beasts  through 
the  room,  at  the  same  time  striking  with  anything  upon 
which  he  could  lay  his  hands.  In  one  of  these  terrible 
paroxysms  he  hurled  his  child  with  such  force  against  the 
wall  that  it  fell  dead.  He  was  tried  for  his  life,  and  the 
jury  found  the  man  was  unconscious  of  the  nature  of  the 


INSANITY.  345^ 

act  which  he  had  committed,  by  reason  of  a  condition 
arising  from  somnambulism,  and  that,  therefore,  he  was  not 
responsible.  When  put  on  trial  the  man  entered  the  fol- 
lowing strange  but  just  plea  :  "I  am  guilty  in  my  sleep, 
but  not  guilty  in  my  senses." 

It  is  probable  that  many  epileptics  have  been  punished 
for  homicide,  theft,  arson,  assault,  and  other  crimes  com- 
mitted without  their  true  volition,  although  the  acts  were 
apparently  purposive ;  but  it  is  often  a  task  of  extreme 
difficulty  to  decide  as  to  the  insanity  of  an  epileptic  at  the 
time  of  the  commission  of  a  crime.  Zacchias  contended  that 
epileptics  should  not  be  responsible  for  any  acts  committed 
within  three  days  of  a  fit,  before  or  after  ;  but  no  rule  can 
be'  invariably  followed.  It  is  not  correct  to  conclude  that 
the  mere  existence  of  epilepsy  is  sufficient  to  establish  un- 
soundness of  mind  and  irresponsibility ;  but  each  case  should 
be  decided  on  its  own  merits,  after  a  careful  investigation  of 
the  family  and  previous  history  of  the  accused  and  of  the 
circumstances  surrounding  the  crime. 

It  is  altogether  probable  that  transitoiy  mania  or  tran- 
sitory frenzy,  so  called,  is  sometimes  epileptic  in  origin, 
although  the  claim  that  has  been  made  that  this  form  of 
insanity  is  always  cerebral  epilepsy  cannot  be  maintained. 
When  a  crime  has  been  committed  in  an  attack  of  transitory 
fury  or  of  apparent  passion,  it  is  important  to  inquire 
closely  as  to  the  existence  of  epilepsy. 

Post-mortem  Lesions  in  Insanity.  —  Modern  research 
has  done  much  to  elucidate  what  was  formerly  very  obscure 
touching  the  true  pathology  of  insanity.  In  every  case  of 
true  insanity,  especially  in  the  chronic  form  of  the  disorder, 
there  are  pathological  changes  produced  in  the  brain, 
although  these  may,  at  times,  be  too  subtle  and  recondite 
29 


346  MEDICAL  JURISPRUDENCE. 

to  be  discovered  by  our  present  means  of  research.  If  it 
be  true  that  every  abnormal  alteration  of  function  in  an 
organ  involves,  for  the  time,  an  alteration  of  structure 
(although  this  may  not  always  be  capable  of  demonstration 
to  the  senses),  it  would  seem  most  reasonable  to  refer  those 
abnormal  displays  of  the  intellectual  and  mental  functions 
which  accompany  insanity  to  some  structural  change  in  the 
different  parts  of  the  cerebral  structure. 

It  is  a  most  vague  and  unsatisfactory  mode  of  expression 
to  speak  of  a  diseased  mind,  as  if  the  incorporeal,  impalpable 
entity  which  we  term  mind  was  the  real  seat  of  disease ; 
whereas  the  true  condition  would  seem  to  be  that  as  the 
mind  can  only  act,  in  our  present  state  of  being,  through 
the  brain,  a  diseased  condition  of  the  latter  organ  mu^t 
necessarily  affect  and  distort  the  different  mental  manifesta- 
tions. The  doctrine  that  insanity  is  due  to  diseased  physical 
media  seems  to  be  most  consistent  with  sound  philosophic 
and  physiologic  views  —  and  we  may  add,  also,  with  sound 
therapeutic  views.  For,  as  has  been  well  urged,  on  what 
other  grounds  do  we  administer  material  remedies  in  cases 
of  insanity,  except  with  the  expectation  that  these  remedies 
will  remove  disease  from  the  media?  When  this  is  ac- 
complished, the  manifestations  of  the  mind's  operations 
again  become  normal  and  natural. 

On  the  other  hand,  it  must  be  remembered  that  exten- 
sive disease  of  the  brain  may  exist,  and  sometimes  exhibit 
pathological  changes  very  similar  to  those  accompanying 
insanity,  without  marked  indications  of  this  disorder.  Why 
this  should  be  so  we  are  unable  distinctly  to  say.  Heredity 
and  other  occult  causes  may  produce  effects  whose  opera- 
tions we  are  not  yet  prepared  fully  to  understand  and 
explain. 


INSANITY.  347 

It  is  a  popular  idea  that  the  largest  brains  are  found  in 
persons  of  the  greatest  intellect  ;  this  is  far  from  the  truth, 
as  one  of  the  largest  on  record  belonged  to  an  idiot. 

In  an  autopsy  of  the  brain  in  a  case  of  insanity,  the  points 
for  consideration  are  its  size,  weight,  and  configuration,  the 
appearance  of  the  convolutions,  depth  of  the  gray  substance, 
and  marks  of  recent  or  chronic  disease.  In  general,  it  may 
be  stated  that,  in  chronic  cases  particularly,  the  appearances 
commonly  met  with  are  thickening  of  the  cranial  bones, 
close  adhesion  of  the  dura  mater,  congestion  of  the  pia 
mater,  with  opacity  and  thickening  of  the  arachnoid.  There 
is  also  general  fullness  of  the  blood-vessels,  with  remains 
of  old  cysts,  hardened  deposits,  or  even  abscesses  in  the 
cerebral  substance  ;  alterations  in  the  form  and  structure 
of  the  convolutions  and  depth  of  the  gray  matter  ;  also 
effusions  of  blood  and  serum,  the  latter  into  the  ventricles, 
together  with  alterations  and  atrophy  of  the  nerve-cells. 

In  Idiocy  and  Imbecility  the  brain  is  usually  smaller  than 
natural  (although  there  are  exceptions),  with  partial  atrophy 
of  the  convolutions,  particularly  the  frontal.  There  is  also, 
generally,  a  want  of  correspondence  between  the  two  lobes. 
The  fissure  of  Sylvius  is  also,  according  to  Luys,  usually 
enlarged,  extending  much  farther  back  than  in  the  normal 
brain.  In  these  cases  there  has  been  a  true  arrest  of  de- 
velopment, depending  upon  some  defect  in  the  cortical 
substance,  from  which  intellectual '  nutrition  should  have 
been  supplied. 

In  Acute  Mania  the  most  common  lesion  is  intense 
hyperemia  along  the  whole  margin  of  the  gray  substance 
of  the  convolutions  and  also  in  areas  below  them.  This 
active  congestion  is  not,  however,  to  be  regarded  as  the 
primary  cause  of  mania  ;  otherwise,  this  latter  disorder  would 


348  MEDICAL   JURISPRUDENCE. 

frequently  be  the  sequence  of  meningitis.  According  to 
Luys,  the  vessels  of  the  corpora  striata  are  most  dilated 
and  engorged. 

Clouston  describes  a  singular  pathological  condition, 
noticed  in  a  case  of  acute  mania,  consisting  of  a  copious 
deposit  of  an  abnormal  material  over  the  entire  convolu- 
tions, "  chiefly  in  their  inner  layers,  and  extending,  in  some 
places,  into  the  white  substance,  and  replacing  at  least 
two  thirds  of  the  gray  substance.  In  many  places  it  was 
deposited  in  masses  around  the  arteries."  But  that  such 
an  abnormal  deposit  is  necessary  to  produce  all  the  symp- 
toms of  violent  mania  is  fully  disproved  (as  the  author 
remarks)  by  the  fact  of  its  entire  absence  in  other  numerous 
cases. 

The  pathological  changes  exhibited  in  chronic  mania  are 
not  pathognomonic.  We  generally  find  thickening  of  the 
membranes,  some  atrophy  of  the  convolutions,  long  con- 
gestions, together  with  disease  of  the  coats  of  the  vessels, 
with  occasional  spots  of  softening.  There  is,  usually, 
thickening  of  the  bones  of  the  skull,  with  occasional  exces- 
sive bony  deposits  on  the  inner  surface. 

In  Melancholia,  "  Luys  found,  in  several  cases,  great 
hyperemia  of  the  gray  substance  of  the  third  ventricle. 
This  gray  matter  on  the  cortex  of  one  of  these  patients 
was  thin,  and  most  of  the  convolutions  were  pale,  with 
irregular  vascular  arborizations.  In  some  cases  of  profound 
melancholia  with  stupor  the  brain  was  completely  exsan- 
guined,  the  white  substance  deprived  of  vessels,  with  atro- 
phy of  the  cortex"  (Hamilton). 

The  pathology  of  epileptic  insanity,  like  that  of  epilepsy, 
yet  remains  very  obscure.  According  to  Dr.  Clouston, 
who  has  examined  numerous  cases  of  this  disorder,  "there 


INSANITY.  349 

is  no  special  lesion  or  abnormality."  Among  other  lesions 
he  has  found  "  spiculae  of  bone  from  the  skull-cap  and 
membranes  pressing  into  the  convolutions,  apoplexies, 
destructive  lesions  of  the  brain  of  all  kinds  and  in  all 
places,  embolisms,  fatty  and  otherwis.e,  adhesions  of  the  pia 
mater  of  the  convolutions,  the  marks  of  traumatic  injuries 
of  all  kinds  and  in  all  places,  unequal  hemispheres,  and 
congestions  of  all  sorts  and  in  all  places."  This  author 
does  not  believe  that  the  source  of  irritation,  in  epilepsy, 
exists  in  the  pons  and  medulla  oblongata,  but  thinks  that 
an  irritation  of  the  motor  area  of  the  convolutions  is  far 
more  apt  to  cause  it  than  one  anywhere  else. 

In  insanity  due  to  syphilis  we  may  expect  to  find  a 
variety  of  pathological  changes,  consisting,  chiefly,  in  thick- 
ening of  the  bones  of  the  cranium,  and  of  the  membranes 
which  adhere  to  the  bones  and  to  the  convolutions  ;  atrophy 
of  the  convolutions,  adventitious  deposits  in  the  gray  mat- 
ter ;  softening  and  disappearance  of  the  white  matter ; 
tumors  (syphilomata)  in  different  places  ;  hypertrophy  of 
the  coats  of  the  arteries,  obliterating  their  lumen,  thus 
causing  atrophy  of  the  structure.  There  is  believed  to  be 
a  tendency  in  syphilis  to  attack  the  brain,  after  having  lain 
latent  for  many  years.  Moreover,  it  appears  that  the  ten- 
dency of  the  disease  toward  the  nervous  system  is  in  the 
inverse  ratio  to  the  development  of  primary  and  secondary 
symptoms. 

In  senile  dementia  the  most  usual  pathological  lesions, 
according  to  Clouston,  are  locaHzed  softenings  of  the  cere- 
bral structure,  the  result  of  cutting  off  the  blood  supply 
through  embolism  ;  atheroma  of  the  arteries,  also  a  marked 
atrophy  of  the  whole  brain  or  of  considerable  portions  of 
the  convolutions.     The   membranes   are   commonly  thick- 


350  MEDICAL  JURISPRUDENCE. 

ened,  and  the  cerebro-spinal  fluid  milky,  superabundant, 
and  full  of  microscopic  debris.  The  large  nerve-cells  are 
degenerated  and  disappearing,  along  with  atrophy  of  the 
smaller  cells  and  nuclei. 

MEDICO-LEGAL   RELATIONS   OF   INSANITY. 

The  duties  of  the  medical  practitioner  in  connection  with 
cases  of  real  or  alleged  insanity  involve  grave  responsibili- 
ties on  his  part,  and  require  the  exercise  of  judgment  and 
caution.  The  most  important  of  these  duties  are  the  fol- 
lowing : 

1.  Assuming  the  responsibility  of  treating  cases  at  home, 
assigning  them  attendants,  restricting  their  liberty,  and  pre- 
venting their  attending  to  their  ordinary  business.  This  is 
a  serious  undertaking,  and  the  physician  will  do  well,  in 
such  cases,  merely  to  act  as  an  adviser,  but  to  assume  no 
responsibility  in  the  restraint ;  this  should  devolve  upon 
some  relative  of  the  patient. 

2.  To  sign  the  proper  certificate  for  the  admission  of  the 
alleged  insane  patient  into  a  public  or  private  asylum.  This 
measure  may  become  necessaiy  both  for  the  good  of  the 
patient  and  for  the  safety  of  the  public ;  but  as  interested 
relatives  and  others  might  possibly  combine  to  commit  a 
sane  person  into  an  asylum,  and  the  physician,  in  such  a 
case,  is  liable  to  be  imposed  upon,  he  should  exercise  the 
greatest  caution  and  judgment  before  giving  his  signature ; 
otherwise  he  renders  himself  liable  to  heavy  punishment, 
by  an  action  at  law,  for  false  commitment.  The  form  of 
certificate  is  fixed  by  statute,  and  no  other  is  valid  in  the 
United  States.  This  must  be  signed  and  sworn  to  by  one 
or  more  respectable  physicians,  who  have  previously  wit- 
nessed and  examined    the    patient.     In   Pennsylvania,  for 


INSANITY.  351 

instance,  the  law  requires  the  signatures  of  twd  physicians 
who  have  been  in  practice  for  at  least  five  years,  and  who 
have  examined  the  patient  separately  within  one  week  of 
their  signatures,  and  who  testify,  under  oath,  of  the  necessity 
of  placing  him  (or  her)  under  the  restraint  of  an  asylum. 
The  person  applying  for  the  admission  of  the  patient  must 
also  sign  a  responsible  bond,  setting  forth  their  reasons  for 
the  request,  giving  a  history  of  the  patient's  symptoms  and 
probable  cause  of  the  attack.  The  physicians  who  sign  the 
certificate  must  have  no  connection  with  the  hospital,  nor 
be  related  by  blood  or  marriage  to  the  patient. 

Before  certifying  to  the  insanity  of  a  patient  under  any 
circumstances,  the  practitioner  should  first  conscientiously 
determine  the  fact  of  the  insanity ;  and,  for  this  purpose, 
he  is  compelled  to  make  a  careful  personal  examination  of 
the  patient.  This  may  require  several  visits  in  some  cases, 
since  the  cunning  of  the  lunatic  may  at  first  baffle  the  phy- 
sician. Then  as  to  the  "  setting  forth  the  facts  "  upon  which 
the  physician's  opinion  is  based,  great  care  and  experience 
are  required,  in  order  to  give  only  such  "facts"  as  are 
really  demonstrative  of  the  alleged  mental  disorder. 

3.  In  the  discharge  of  lunatics  the  same  caution  and 
judgment  are  required  on  the  part  of  the  physician. 
Patients  sometimes  obtain  their  discharge  from  an  asylum, 
contrary  to  the  wishes  of  the  superintendent,  on  a  writ  of 
habeas  corpus^  and  they  not  infrequently  bring  an  action 
against  both  the  superintendent  and  the  physicians  who 
signed  the  certificate  for  false  detention.  But  generally 
they  are  removed  by  their  friends,  when  sufficiently  recov- 
ered, at  the  discretion  of  the  superintendent.  In  this 
country  there  is  no  legal  restriction  on  the  liberation  of  the 
insane  on  their  recovery,  except  in  cases  of  homicidal,  or 


352  MEDICAL    JURISPRUDENCE. 

otherwise  dangerous,  lunatics  who   have  been  confined  by_ 
order  of  the  courts. 

4.  Medical  men  are  often  called  upon  to  give  evidence  as 
to  the  existence,  or  not,  of  insanity  in  a  criminal  under 
sentence  of  death,  in  order  to  stay  execution.  For  this 
purpose  it  is  usual  for  the  court  to  appoint  a  commission  of 
three  or  more  persons,  the  majority  experienced  physicians, 
to  determine  the  question. 

5.  When  a  defense  of  the  prisoner  is  based  upon  alleged 
insanity,  the  court  summons  experts,  whose  duty  it  is  to 
determine,  as  far  as  possible,  the  patient's  mental  condition 
both  before  and  at  the  time  of  the  commission  of  the  crime. 

6.  In  civil  cases  the  physician  is  constantly  appealed  to, 
as,  e.  g.,  to  determine  the  testamentary  capacity  of  one 
making  a  will,  or  signing  a  contract,  or  contracting  a  mar- 
riage, or  transacting  ordinary  business.  As  regards  testa- 
mentaiy  capacity,  it  is  understood  that  the  law  requires 
a  less  amount  of  mental  capacity  for  making  a  will  than 
for  managing  property  or  enjoying  personal  liberty.  Pa- 
tients in  asylums  have  made  wills  which  the  courts  have 
sustained.  Patients  with  insane  delusions  that  did  not 
affect  the  provisions  of  the  will,  and  which  were  just  and 
reasonable,  have  been  held  by  the  highest  tribunals  to 
have  made  good  wills.  Thus,  a  person  suffering  from  re- 
ligious melancholia,  under  the  delusion  that  he  had  com- 
mitted the  unpardonable  sin,  but  manifesting  mental  sound- 
ness in  other  respects,  as  indicated  by  his  correct  business 
transactions,  undoubtedly  is  possessed  of  testamentary 
capacity.  His  insane  delusion  does  in  no  wise  affect  the 
matter  at  issue  —  viz.,  his  ability  to  dispose  of  his  property. 
But  it  would  be  altogether  different  if  his  delusions  took  a 
different  shape ;  if,  for  example,  he  believed  that  one  of  his 


INSANITY.  353 

children  had  attempted  to  poison  him,  and,  in  consequence 
of  this  false  notion,  he  had  disinherited  that  child  ;  in  such 
a  case — inasmuch  as  the  delusion  may  have  directly  af- 
fected the  provisions  of  the  will  —  they  should  be  regarded 
as  impeaching  the  testamentary  capacity.  Under  such 
conditions  he  could  not  be  considered  as  possessing  a  dis- 
posing mind.  The  most  absurd  and  eccentric  wills  have 
been  held  by  the  courts  to  be  vaHd,  where  such  wills  were 
shown  to  be  in  perfect  accordance  with  the  whole  former 
life  and  character  of  the  eccentric  (but  not  insane)  testator. 

In  order  to  make  a  valid  will,  the  law  requires  that  the 
testator  should  be  sane  at  the  time  he  makes  it.  Hence, 
temporary  drunkenness,  the  delirium  of  a  fever,  narcotism, 
and  similar  conditions  would,  for  the  time,  disqualify  him. 
But  a  person  may  be  suffering  from  the  effects  of  a  powerful 
poison  —  arsenic  or  strychnine,  for  instance;  provided  his 
brain  is  not  affected  so  that  his  intelligence  is  impaired, 
his  will  made  under  these  circumstances  will  be  perfectly 
valid.  The  question  has  been  raised  of  the  validity  of  a 
will  made  by  a  person  suffering  from  typhoid  fever ;  the 
answer  should  certainly  be  affirmative,  provided  he  was  not 
dehrious  at  the  time.  In  an  English  case  it  was  held  that 
neither  erysipelas  nor  fever  would  invalidate  a  will,  but  that 
the  stupor  and  drowsiness  induced  by  them  would. 

As  regards  paralysis,  it  has  been  settled  that  this  is  not 
sufficient  to  invalidate  a  will,  even  if  it  be  accompanied  with 
aphasia  or  loss  of  speech,  always  provided  the  mental 
powers  were  good.  The  same  is  true  of  the  collapse  of 
cholera,  where  the  patient  is  unable  to  speak  from  .exhaus- 
tion, but  where  the  mental  powers  continue  unimpaired. 

In    epilepsy,  unless  it  can  be  proved  that  the  repeated 
attacks  have  affected  the  mind,  so  as  to  have  completely 
30 


354  MEDICAL    JURISPRUDENCE. 

unhinged  it,  it  has  been  decided  that  the  patient  has  a  per- 
fect testamentary  capacity  in  the  intervals  between  the 
paroxysms.  The  case  of  the  Duchess  of  Manchester 
(1854)  is  one  in  point.  She  executed  a  second  will  about 
three  weeks  before  her  death.  She  had  repeated  attacks  of 
hysteria  and  convulsions  along  with  delusions.  The  attend- 
ing physician  deposed  that  on  the  day  of  executing  the 
will,  and  for  some  days  previous,  the  duchess  had  recov- 
ered her  reason,  and  that  at  the  time  of  signing  it  she  was, 
in  his  judgment,  aware  of  what  she  was  doing,  and  that  she 
voluntarily  delivered  it  as  her  own  act  and  deed.  It  ap- 
peared also  that  the  disputed  will  was  substantially  such  as 
the  duchess  had  announced  before  that  it  was  her  intention 
to  make.  At  the  trial  several  medical  witnesses  gave  their 
opinion  that  the  duchess  was  of  unsound  mind,  and,  there- 
fore, incapable  of  making  a  will.  But  the  point  at  issue 
was  —  Was  she  at  the  time  of  executing  the  will  in  a  com- 
petent state  of  mind  ?  The  jury  found  that  she  was  com- 
petent, and  that  the  will  was  valid. 

When  a  physician  is  asked  to  examine  into  the  testa- 
mentary capacity  of  a  patient  before  executing  his  will,  it 
will  be  well  that  the  interview  should  be  strictly  private,  or 
else  in  the  presence  of  the  nurse,  or  some  one  member  of 
the  family,  in  order  to  ascertain  the  true  condition  of  his 
mind  :  whether  it  is  free  from  the  action  of  drink  or  nar- 
cotics ;  whether  he  properly  understands  the  nature  of  the 
act  he  is  to  perform  ;  whether  he  is  influenced  as  to  the 
manner  of  doing  it  by  any  insane  delusions  prompting  him 
thereto  ;^  and,  finally,  whether  any  undue  influence  is  being 
exerted  over  him  from  without.  It  may  happen  that  in  a 
private  interview  a  dying  man  might  disclose  to  his  physi- 
cian the  fact  of  such  an  improper  influence,  from  which  he 


INSANITY.  355 

was  desirous  of  escaping,  but  which  had  become  dominant 
over  him  in  consequence  of  his  weakness. 

7.  The  medical  man  may  be  asked  his  opinion  in  refer- 
ence to  the  propriety  of  contracting  a  marriage  with  a  party 
who  has  been  insane  or  who  has  an  insane  heredity.  This 
is  often  a  most  dehcate  and  responsible  position  for  him  to 
occupy.  Undoubtedly,  physicians  will  be  generally  averse 
to  marriage  when  either  party  has  been  insane  ;  certainly, 
if  there  exists  a  histoiy  of  insanity  in  the  family,  the  risk 
is  very  great.  A  sporadic  case  of  insanity,  depending  on 
some  special  cause  and  perfectly  curable,  may  occur  in  any 
family ;  this  might  be  excepted  from  the  advice  above  given. 

8,  Then,  also,  as  to  the  proper  training  and  education  of 
children  of  insane  or  neurotic  parents,  medical  advice  is 
often  very  properly  sought  and  followed.  Such  children 
should,  of  course,  be  brought  up  on  strictly  physiologic 
and  hygienic  principles.  Pure  air,  simple  but  nourishing 
diet,  plenty  of  outdoor  exercise,  the  avoidance  of  all  im- 
proper excitement,  especially  toward  the  period  of  puberty, 
and  the  subordination  of  their  intellectual  studies  to  their, 
physical  health — these  are  the  points  to  which  the  atten- 
tion should  be  specially  directed. 

CRIMINAL  RESPONSIBILITY— THE  PLEA  OF  INSANITY  AS  A 
BAR  TO  CAPITAL  PUNISHMENT. 

There  is  no  aspect  of  insanity  of  more  profound  interest 
to  the  medical  jurist,  nor  of  greater  importance  both  to  him 
and  to  the  community,  than  that  of  responsibility  in  crim- 
inal cases.  After  clearing  away  much  irrelevant  matter 
that  prevents  a  clear  comprehension  of  the  subject  of  crim- 
inal responsibility — divesting  it  of  all  its  mere  technicalities 
and  subtleties  —  we  come  to  the  true  test  —  mental  disturb- 


356  MEDICAL   JURISPRUDENCE. 

ance  arising  from  disease.  In  the  words  of  Dr.  Bucknill  : 
"  The  element  of  disease,  therefore,  in  abnormal  conditions 
of  mind,  is  the  touchstone  of  irresponsibility,  and  the  detec- 
tion of  its  existence  or  non-existence  is  the  peculiar,  and 
oftentimes  the  difficult,  task  of  the  psychopathist." 

But  the  question  immediately  occurs  —  How  is  the  exis- 
tence of  this  alleged  mental  disorder  to  be  determined  ? 
What  are  the  tests  of  its  presence  in  the  criminal  at  the  bar 
of  justice?  In  England,  formerly,  the  doctrine  was  "that 
every  man  was  responsible  for  his  acts  unless  he  was  totally 
deprived  of  his  understanding  and  memory,  and  did  not 
know  what  he  was  doing,  no  more  than  an  infant,  than  a 
brute,  or  a  wild  beast."  In  the  case  of  Bellingham,  "the 
knowledge  of  right  and  wrong"  in  the  abstract  was  the 
test  of  mental  unsoundness ;  and  as,  in  the  opinion  of  the 
judge  and  juiy,  he  was  held  to  be  capable  of  solving  this 
metaphysical  problem,  Bellingham  was  duly  hanged.  Since 
the  trial  and  acquittal  of  MacNaughton  for  the  murder  of 
Mr.  Drummond,  on  the  ground  of  insanity,  the  doctrine  of 
the  knowledge  of  abstract  right  and  wrong  has  been  changed 
to  a  knowledge  of  right  and  wrong  in  relation  to  the  par- 
ticular act  of  which  the  person  is  accused,  and  also  at  the 
time  of  committing  it  (Husband).  But  a  step  further  has 
been  taken  in  declaring  "  he  must  also  have  a  knowledge 
of  the  consequences  of  the  act." 

The  knowledge  of  the  difference  between  right  and 
wrong  has  been  the  test  for  years  ;  yet  it  is  unsatisfactory. 
No  doubt  many  insane  persons  have  committed  acts  which 
they  knew  to  be  wrong,  and  of  the  criminality  of  which 
they  were  at  the  time  perfectly  conscious ;  as  they  were 
also  of  their  penal  consequences.  Some  have  been  known 
to  commit  murder  with  the  avowed  intention  of  receiving 


INSANITY.  357 

the  punishment  of  death  at  the  hands  of  the  law,  instead 
of  inflicting  it  suicidally  upon  themselves.  Dr.  Maudsley 
criticises  the  above  "test"  very  truly  when  he  says: 
"  Here  is  an  unhesitating  assumption  that  a  man  having  an 
insane  delusion  has  the  power  to  think  and  act  in  regard  to 
it  reasonably ;  that  he  is,  in  fact,  bound  to  be  reasonable  in 
his  unreason,  sane  in  his  insanity." 

The  decisions  in  the  American  courts  have  generally 
been  similar  to  those  of  England,  the  dominant  idea  being 
a  knowledge  on  the  part  of  the  criminal  of  the  wrong  nature 
of  the  act  in  question  —  "its  criminality,  not  only  against 
the  laws  of  man,  but  also  against  the  laws  of  God  and 
nature."  The  doctrine  laid  down  by  Mittermaier  is  thought 
by  some  to  cover  the  ground  more  completely.  He  re- 
gards the  will  as  the  most  important  factor  in  the  case. 
He  rebukes  the  English  jurists  for  their  rigid  adherence  to 
the  antiquated  doctrine,  that  whoever  can  distinguish  good 
from  evil  enjoys  freedom  of  will,  and  retains  the  faculty  (if 
he  choose  to  use  it)  of  framing  his  action  to  the  requirements 
of  the  law.  "  A  person  who  commits  a  criminal  act,  being 
fully  cognizant  of  the  nature  of  the  law,  and  of  the  punish- 
ment to  which  he  is  exposing  himself,  may  yet  be  of  insane 
mind.  The  true  test  of  irresponsibility  should  be,  not 
whether  the  party  accused  was  aware  of  the  criminality  of 
his  action,  but  whether  he  has  lost  all  power  of  control 
over  his  actions."  According  to  Hamilton,  "the  true  test, 
after  all,  is  the  condition  of  the  will."  With  this  Ordro- 
naux  substantially  agrees  when,  speaking  of  criminal  re- 
sponsibility, he  adds,  in  addition  to  the  defendant  knowing 
the  nature  and  consequences  of  the  act,  and  having  a 
felonious  intent  in  its  commission,  that  "  he  had  the  power 
to  choose  between  doing  and  not  doing  it ;  and,  supposing 


358  MEDICAL   JURISPRUDENCE. 

this  power  to  be  lost,  it  is  lost  solely  through  disease,  and 
not  through  temporary  inebriety  or  violent  anger." 

The  above  doctrine  seems  to  be  sound  ;  it  is  founded  on 
psychologic  principles,  and  certainly  cannot  be  accused  of 
bearing  harshly  or  inhumanly  against  a  prisoner.  It  places 
his  irresponsibility  for  the  criminal  act  exactly  where  it 
ought  to  be  placed  —  on  a  distorted  mind.  Moreover,  a 
thorough  understanding  of  these  views  by  medical  experts, 
and  a  more  general  dissemination  through  the  community  of 
the  important  doctrine  that  insanity  is  a  disease,  and  not  a 
mere  outburst  of  anger,  or  even  a  series  of  emotional  acts, 
will  contribute  not  a  little  to  educate  the  people  as  to  the 
reasonable  and  proper  grounds  to  be  taken  in  those  cases 
of  homicide  in  which  the  plea  of  insanity  is  urged. 

Impulsive  or  emotional  insanity,  as  it  is  named,  is  often 
urged  as  a  defense  for  crime,  especially  homicide.  Is  the 
plea  a  sound  one  ?  Can  it  be  possible  that  an  individual 
can  be  sane  immediately  before  and  immediately  after  the 
commission  of  an  act,  and  insane  only  at  the  moment  of  its 
commission  ?  A  well-known  writer  thus  expresses  himself: 
"  I  see  no  ground  on  which  to  rest  a  hypothesis  of  an  im- 
pulsive insanity,  or  to  justify  an  incorporation  in  our  medical 
jurisprudence  of  such  a  form.  I  cannot  conceive  of  a 
homicidal  act,  impulsive  without  motive,  delusion,  or  pas- 
sion, simply  a  so-called  impulse  to  kill ;  and  a  careful 
analysis  of  clinical  cases  under  my  own  observation,  as  well 
as  a  large  experience  in  the  examination  of  criminals,  sus- 
tains this  view.  Impulsive  disease  can  not  exist.-  The  term 
impulse,  used  to  describe  certain  acts  of  the  insane,  exe- 
cuted suddenly  and  without  apparent  premeditation,  may 
be  proper  enough  as  qualifying  a  mental  state  during  an 
act,  as  impulsive   homicide,  but  this  does   not  justify  the 


INSANITY.  359 

transposition  into  homicidal  impulse.  Such  transposition 
would  show,  not  that  the  acts  were  apparently  unpremedi- 
tated and  sudden,  but  that,  in  the  mind  there  was  suddenly 
generated  a  murderous  impulse,  an  irresistible  power,  which, 
without  the  intervention  of  reason,  or  any  intellectual  act 
or  motive,  suddenly  impels  to  the  physical  act.  Man  is 
not  the  prey  to  blind  impulse."      (Quoted  by  Hamilton.) 

SIMULATED   OR   FEIGNED   INSANITY. 

There  is  probably  no  subject  in  medico-legal  practice 
which  causes  the  physician  more  trouble  and  anxiety  than 
the  disputed  mental  condition  of  an  individual.  If  the 
question  of  feigned  bodily  diseases  often  occasions  consid- 
erable difficulties,  how  much  greater  will  be  his  perplexity 
and  doubt  when  he  comes  to  deal  with  the  subtle  workings 
of  the  mental  operations.  Insanity  is  not  infrequently  pre- 
tended by  persons  accused  of  criminal  offenses,  in  order  to 
procure  an  acquittal,  or  a  discharge  from  prison.  In  the 
first  place,  when  feigning  is  suspected,  we  should  ascertain 
whether  there  was  a  motive  for  pretending  to  be  insane. 
Remember  that  insanity  is  rarely,  if  ever,  assumed  until  after 
the  commission  of  a  crime  and  the  detection  of  the  criminal. 

A  further  important  point  is,  to  ascertain  if  the  criminal 
deed  was,  or  was  not,  an  isolated  act  in  the  mental  life  of 
the  culprit  —  whether  it  originated  suddenly  in  his  mind, 
like  a  flash  of  lightning  from  an  unclouded  sky,  or 
"whether  it  was  not  rather  the  last  link  of  a  long  chain 
of  sinful,  criminal  desires,  hopes,  and  acts."  In  other 
words,  to  ascertain  if  it  was  not  just  such  an  act  as  might 
have  been  expected  from  the  culprit.  This  investigation  is 
of  the  utmost  importance,  since  it  does  not  usually  happen 
that  a  person  should  suddenly  act  in  a  manner  diametrically 


360  MEDICAL   JURISPRUDENCE. 

opposite  to  all  his  former  character,  without  some  powerful 
psychologic  cause. 

I'his  inquiry  into  motive  is  often  of  primary  importance 
in  the  alleged  insanity  of  criminals.  The  motiveless  char- 
acter of  a  deed  is  very  apt  to  impress  us  with  a  lack  of  good 
sense,  if  not  of  positive  mental  weakness,  in  its  author. 
Hence,  if  we  can  discover  a  true  motive  for  a  criminal  act, 
especially  if  the  motive  agrees  with  the  disposition  and 
character  of  the  culprit  (an  important  consideration),  this 
would  go  very  far  to  establish  the  responsibility  of  the 
accused  at  the  time  of  the  commission  of  the  crime,  despite 
all  his  affectation  of  insanity. 

There  is  often  great  difficulty  in  getting  at  this  motive. 
In  some  cases  there  is  no  apparent  motive  ;  but  we  should 
not  be  too  ready  to  admit  its  absence,  since  it  is  indisput- 
ably true  that  there  are  as  many  different  motives  to  illegal 
action  as  there  are  different  characters ;  and  what  would  be 
a  powerful  motive  to  one  person  might  have  no  influence 
whatever  over  another,  placed  under  different  surroundings. 
"  In  order  to  recognize  this  fact,  the  inquirer  must,  in  every 
case,  place  himself  in  the  position  of  the  culprit,  and  divest 
himself  of  his  own  ideas."  ..."  No  crime,  be  it  what 
it  may,  is  ever  committed  without  a  motive ;  and  the  char- 
acter of  that  motive  may  be  expressed  thus  :  '  the  conscious 
impulse  to  the  illegal  gratification  of  a  selfish  desire'" 
(Casper). 

A  third  point  in  the  detection  of  feigned  insanity  is  to 
ascertain  whether  the  culprit,  in  carrying  out  the  deed  of 
which  he  is  accused,  has  acted  according  to  any  regular 
plan  or  not.  In  most  cases,  however,  this  is  of  but  little 
diagnostic  value,  since  many  confirmed  lunatics  evince  the 
most    surprising    adroitness    in    planning   and    executing 


INSANITY.  361 

schemes  for  escape,  or  for  enticing  their  victims  whom  they 
intend  to  murder. 

One  thing,  however,  should  be  remembered  in  this  con- 
•nection  :  generally  speaking,  in  a  case  of  real  insanity  the 
individual  will,  so  to  speak,  break  down  before  he  is  quite 
through  ;  that  is,  he  will  do  or  say  something  which  will 
betray  his  mental  debility.  Thus,  an  insane  patient  in  a 
private  asylum  near  London,  with  the  greatest  artfulness 
managed  to  steal  a  piece  of  iron,  with  which  he  subsequently 
sawed  through  the  bars  of  his  windows,  and  brought  to 
success  his  long-cherished  plan  of  flight.  These  circum- 
stances proved  the  calmest  and  most  systematic  deliberate- 
ness.  But  here  his  reason  forsook  him  :  after  his  escape, 
he  ran  straight  to  the  Duke  of  Wellington's  house,  and 
announced  himself  as  his  eldest  son, 

A  fourth  point  to  be  noticed  in  the  diagnosis  of  a  case  of 
pretended  insanity  is,  whether  the  culprit  has  taken  any 
measures  to  avoid  arrest  or  punishment.  Whether,  for 
instance,  he  had  adopted  any  disguise  in  his  personal  ap- 
pearance or  dress,  such  as  removing  his  beard  or  putting 
on  a  false  one,  dyeing  his  hair,  etc.,  or  making  preparations  for 
escape,  or  waiting  for  the  darkness  of  the  night  for  the  per- 
petration of  the  deed.  All  such  circumstances  would  create 
a  strong  suspicion  that  the  accused  pretty  clearly  recognized 
the  responsibility  of  the  deed.  The  really  irresponsible 
criminal  will  usually  evince  a  total  apathy  about  the  result, 
and  will  display  a  feeling  of  the  utmost  security,  often  exult- 
ing in  the  deed,  which  may  even  have  been  committed 
against  one  of  his  own  immediate  family. 

A  fifth  important  consideration  in  relation  to  the  diagnosis 
is  the  peculiar  condition  of  the  intelligence  of  the  accused 
as  ascertained,  on  examination,  to  have  always  existed,  or 


362  MEDICAL   JURISPRUDENCE. 

at  least  for  a  long  time  previous  to  the  commission  of  the 
criminal  act  (Casper).  For  example,  a  person  may  be 
claimed  as  insane,  because  of  alleged  feeble-mindedness,  as 
displayed  in  inability  to  count,  to  read  and  write,  to  carry 
on  a  continued  conversation,  and  the  like  ;  but  all  this  may 
be  satisfactorily  answered  by  showing  that  the  person  has 
had  no  previous  education  whatever,  and  consequently  no 
opportunity  of  learning  any  of  the  above  matters.  Hence 
the  allegation  of  his  being  "silly,"  "childish,"  "simple," 
etc.,  can  be  of  no  avail  as  producing  irresponsibiHty  for  his 
particular  crime.  Here  the  related  facts  must  be  ascertained 
in  reference  to  the  case  in  question  —  his  family  histoiy,  his 
mode  of  bringing  up,  his  manner  of  life,  etc.,  together  with 
the  relation  of  the  deed  for  which  he  is  accused  to  the 
sphere  of  his  intelligence. 

Another  point  to  be  noticed  is  the  distinction  between 
the  hallucinations  of  the  really  insane  and  the  alleged 
"voices  "  and  "  impulses  "  of  the  pretender,  forcing  him  on 
to  the  commission  of  his  crime.  It  may  safely  be  asserted 
that,  whenever  hallucinations  accompany  real  insanity,  the 
latter  will  display  itself  by  other  unmistakable  signs,  so  that 
by  attentive  watching  we  can  generally  succeed  in  distin- 
guishing the  genuine  from  the  pretended. 

A  strong  circumstance  bearing  on  the  detection  of  sus- 
pected insanity  is  the  fact  that,  in  a  genuine  case  of  the 
disease,  the  person  will  not  admit  that  he  is  insane  ;  while 
the  pretender  will  use  all  his  efforts  to  make  you  believe  he 
is  mad.  So  thoroughly  is  this  the  case  that  an  impostor 
may  be.  induced  to  perform  any  act,  if  it  be  casually  ob- 
served to  another  in  his  hearing  that  the  performance  of 
such  an  act  would  furnish  strong  evidence  of  his  insanity. 

Mania  is  probably    more    frequently   feigned  than    any 


INSANITY.  363 

other  form  of  insanity,  from  the  popular  notion  that  insanity 
is  made  up  of  violent  action  and  vociferous  and  incoherent 
language.  But  mania  seldom  comes  on  suddenly  without 
some  obvious  cause.  A  maniacal  patient  is  equally  furious 
by  night  and  by  day  ;  an  impostor  sleeps.  Real  mania 
manifests  itself  equally  when  the  patient  is  alone  or  in  com- 
pany ;  an  impostor,  only  when  he  thinks  he  is  observed. 
The  peculiar  restless  expression  of  the  eye  of  mania  is  hard 
to  imitate.  The  pulse,  temperature,  state  of  skin,  etc.,  of 
the  genuine  disorder  cannot  be  assumed  by  the  impostor. 
Dementia  is  more  difficult  to  imitate.  The  discovery  of 
any  connected  ideas,  reasoning,  or  reflection,  either  by  lan- 
guage, signs,  or  writing,  would  immediately  show  that  the 
patient  was  simulating. 

Occasional  instances,  however,  are  presented  of  a  suc- 
cessful malingering  in  this  line  which  baffle  the  detective 
skill  of  the  most  experienced  examiners.  Dr.  Bucknill 
mentions  the  case  of  Warner,  a  notorious  thief,  who  was 
sentenced  to  transportation  for  fourteen  years.  Two  days 
after  the  trial  he  became  apparently  insane  ;  he  constantly 
made  howling  noises,  was  filthy  in  his  habits,  tore  up  his 
clothes,  destroyed  his  bedding  and  other  articles.  He  was, 
however,  suspected  of  shamming  and  was  detained  in  prison 
for  three  months.  During  part  of  this  time  it  was  found 
necessary  to  keep  him  in  a  straight  waistcoat.  At  length 
a  certificate  of  insanity  was  forwarded  to  the  Secretary  of 
State,  and  he  was  ordered  to  be  removed  to  the  Devon 
County  Asylum.  On  admission  here  he  was  found  to  be 
in  feeble  health.  He  had  an  oppressed  and  stupid  expres- 
sion of  face  ;  he  answered  no  questions,  but  was  constantly 
muttering  to  himself,  remaining  in  the  same  position  for 
hours,  either  in  a  standing  or  sitting  posture.     He  was  now 


364  MEDICAL    JURISPRUDENCE. 

not  dirty  in  his  habits  ;  he  appeared  to  be,  in  truth,  suffering 
from  acute  dementia.  In  three  weeks'  time  he  recovered 
his  bodily  health.  This  change  was  too  rapid  not  to  suggest 
the  idea  of  deception,  but  the  preceding  symptoms  had 
been  so  true  to  nature  that  it  was  still  thought  that  the 
insanity  had  not  been  feigned.  For  a  period  of  eight 
months  he  was  well  conducted  and  industrious  and  he 
showed  no  symptoms  of  insanity.  At  the  end  of  that 
time  he  was  returned  to  the  jail  to  undergo  his  sentence, 
and  within  one  hour  after  his  readmission  within  its  portals 
he  was  apparently  afflicted  with  a  relapse  of  his  insanity. 
From  this  time,  for  a  period  of  two  years,  this  indomitable 
man  persisted  in  simulating  mental  derangement.  He 
refused  to  answer  questions,  walking  to  and  fro,  constantly 
howling,  and  refusing  food  for  days  together.  He  would 
keep  beating  at  the  door  of  his  cell,  tearing  up  his  bed- 
clothes over  and  over  again  ;  he  had  a  stupid  expression  of 
countenance,  but  he  slept  soundly.  He  became  filthy  in 
his  habits,  but  was  cured  of  this  by  the  hot  bath.  He  was 
often  visited  by  the  physician,  who  said  he  was  a  malin- 
gerer. After  two  years  he  suddenly  gave  up  and  acknowl- 
edged the  deception. 


CHAPTER  XIV. 

MALPRACTICE. 

Malpractice  (or  malpraxis),  may  be  defined  to  be  bad  or 
wrong  practice  —  bad  or  wrong  in  its  results,  whether  these 
be  loss  of  limb  by  amputation,  deformity,  serious  injury  to 
health,  or  even  death. 

The  responsibility  of  physicians  has  ever  been  a  fruitful 
theme  for  discussion.  It  is  comparatively  rare  that  the  sub- 
ject becomes  the  source  of  a  criminal  prosecution,  except  in 
cases  of  feticide  resulting  in  the  death  of  the  mother ;  but 
actions  for  damages  before  the  civil  courts,  often  for  large 
amounts,  are  alarmingly  frequent,  and  may  well  call  upon 
the  medical  men  to  consider  what  their  exact  legal  standing 
is  in  this  matter,  and  what  protection  they  are  entitled  to 
claim  from  the  law,  when  thus  assailed. 

In  the  first  place,  it  should  be  clearly  understood  that 
the  physician  or  surgeon,  when  called  to  treat  a  case  of 
disease  or  injury,  does  not  become  an  insurer  or  guarantor 
to  cure,  any  more  than  an  attorney  obligates  himself  to  win 
the  case  for  his  client.  In  both  instances,  the  professional 
man  merely  undertakes  to  do  his  best — "to  bring  to  the 
exercise  of  his  profession  a  reasonable,  fair,  and  competent 
degree  of  skill."  The  medical  man  should  always  beware 
of  compromising  himself  by  a  promise  to  cure  his  patient ; 
if,  however,  he  be  so  unwise  as  to  have  made  such  a  con- 
tract, he  will  be  held  by  the  law  strictly  accountable  for  its 
performance.     In  case  of  failure,  it  will  be  no  defense  for 

365 


366  MEDICAL   JURISPRUDENCE, 

him  to  allege  the  occurrence  of  unforeseen  contingencies, — 
these  he  was  bound  to  have  knowledge  of.  Neither  may- 
he  allege  a  want  of  sufficient  skill  or  dexterity ;  these  he  is 
supposed  by  the  law  to  possess  when  he  undertook  the 
case.  Thus,  if  a  surgeon  contracts  to  cure  a  patient  of 
deformity  by  the  removal  of  a  limb,  and  death  ensues 
through  pyemia  or  erysipelas,  he  will  be  held  liable  for  for- 
feiture of  his  contract.  Or  if  he  undertakes,  by  contract, 
to  cure  a  woman  of  an  abdominal  tumor  by  the  operation 
of  ovariotomy,  and  death  results  through  an  unavoidable 
peritonitis,  this  will  not  excuse  him.  So,  likewise,  a  lawyer 
contracting  for  the  foreclosure  of  a  mortgage  will  be  held 
liable  to  his  client,  in  case  of  failure  on  his  part.  In  all 
these  instances,  the  contract  will  bind  the  parties.  Their 
fault  and  folly  was  to  have  undertaken  what  was  beyond 
their  capacity  to  perform. 

In  all  ordinary  cases,  where  there  is  no  express  stipula- 
tion between  the  parties,  the  medical  man  impliedly  agrees 
to  bring  his  best  skill  and  endeavors  to  cure  the  patient. 
Formerly,  the  lav/  made  a  distinction  between  a  fatal  issue 
following  the  treatment  of  the  regular  physician  and  that 
of  the  quack,  regarding  the  former  as  only  a  "  misadven- 
ture," but  punishing  the  latter  as  manslaughter.  At  present, 
both  in  the  United  States  and  Great  Britain,  this  distinction 
has  been  abandoned,  the  court  regarding  all  systems  of 
medicine  as  being  entirely  on  a  par,  so  that,  if  the  practi- 
tioner announces  himself,  or  herself,  as  belonging  to  any 
particular  school  or  system  of  medicine,  and  practicing  as 
such,  the  patient  who  employs  such  a  practitioner,  and 
suffers  thereby  either  in  limb  or  life,  has  no  legal  redress ; 
he  has  made  his  election,  and  must  abide  the  consequences. 
Indeed,  it  would  appear  that  the  charlatan  is,  under  the 


MALPRACTICE.  36/ 

present  system  of  law,  much  more  likely  to  escape  in  a  suit 
for  malpractice,  than  the  most  experienced  regular  physician. 

It  may  not  be  always  easy  to  determine  just  what  "the 
ordinary  degree  of  skill  "  used  by  law  authorities  means, 
since  what  might  be  regarded  as  an  ordinary  degree  of  skill 
in  a  large  city,  or  center  of  medical  learning,  would  prob- 
ably be  considered  by  the  untaught  and  inexperienced 
residents  on  the  frontiers  of  civilization  as  very  extra- 
ordinary skill,  and  vice  versa.  Consequently,  this  term, 
"  ordinary  skill,"  must  have  a  varied  latitude  of  application, 
according  to  the  circumstances  of  individual  cases. 

The  following  principles  may  be  regarded  as  established, 
being  founded  on  various  judicial  decisions,  both  in  this 
countiy  and  in  England  :  — 

I.  If  the  practitioner  acted  honestly,  and  used  his  best 
skill  to  cure,  and  it  does  not  appear  that  he  thrust  himself 
in  the  place  of  a  more  competent  person,  it  makes  no  differ- 
ence whether  he  was,  at  the  time,  a  regular  or  an  irregular 
physician  or  surgeon.  This  principle  has  been  stretched 
to  its  utmost  limits,  even  where  death  has  unquestionably 
resulted  from  the  practice  of  notorious  quacks,  such  as  St. 
John  Long  and  Samuel  Thompson,  although  the  grossest 
ignorance  was  proven  against  both  of  them.  In  the  case  in 
which  an  ignorant  old  man  practicing  obstetrics,  on  one 
occasion  mistook  a  prolapsed  uterus  for  a  placenta,  and  tore 
it  away  by  main  force,  causing  fatal  hemorrhage.  Lord 
EUenborough,  C.  J.,  charged  that  "  there  was  not  a  particle 
of  evidence  to  convict  the  prisoner  of  the  crime  of  murder." 
The  prisoner  was  acquitted.  This  case  illustrates,  as  Elwell 
justly  remarks,  how  ignorant  a  Lord  Chief  Justice  of  Eng- 
land may  be  as  to  the  science  of  medicine.  He  appeared 
to   suppose   that   because    an  ignorant  old  man   had   the 


368  MEDICAL    JURISPRUDENCE, 

temerity  to  act  the  part  of  an  obstetrician  among  a  class 
of  ignorant  women,  that  therefore  he  must  necessarily  have 
some  skill  —  a  most  absurd  proposition.  "  It  no  more  in- 
ferred '  some  degree  of  skill '  in  the  prisoner,  because  he 
had  delivered  some  women  successfully  before,  than  the 
fact  that  a  woman  who  has  delivered  herself  of  ten  or  a 
dozen  children,  which  is  often  the  case,  is  evidence  that  she 
possesses  some  knowledge  of  the  uterine  system."  Un- 
questionably, such  a  lack  of  anatomic  knowledge  as  would 
cause  a  man  to  mistake  a  uterus  for  a  placenta  should  be 
classed  as  the  grossest  ignorance,  and  should  subject  the 
pretender  to  severe  punishment. 

II.  Not  only  ordinary  skill,  but  ordinary  care  and  atten- 
tion to  the  patient  are  required  of  the  attending  practitioner. 
If  a  surgeon,  for  example,  after  skillfully  performing  an 
operation,  neglects  the  after-treatment,  such  as  proper  dress- 
ing and  bandaging,  and,  in  consequence  thereof,  hemor- 
rhage, pyemia,  mortification,  or  deformity  should  result,  he 
will  be  justly  held  responsible  in  an  action  for  malpractice. 
In  every  such  case,  however,  if  the  defendant  can  clearly 
prove  these  two  points  —  an  average  amount  of  skill  and 
competency,  together  with  a  proper  degree  of  careful  atten- 
tion on  his  part  —  he  may  feel  certain  of  an  acquittal,  unless 
the  trial  should  happen  to  be  before  a  stupid  jury  and  a 
prejudiced  judge. 

III.  As  medical  men  are  not  infallible,  the  most  skillful 
may  err  in  judgment  in  advising  a  particular  remedy,  about 
which  there  is  a  difference  of  opinion.  An  error  of  judg- 
ment made  by  such  a  practitioner  is  clearly  excusable. 
Lord  Mansfield,  speaking  of  attorneys,  says  :  "  Every  man 
is  Hable  to  errors,  and  I  should  be  very  sorry  to  think  that 
it  should  be  taken  for  granted  that  an  attorney  is  answerable 


MALPRACTICE.  369 

for  every  error  or  mistake,  and  to  be  punished  for  it  by 
being  charged  with  the  debt  he  was  employed  to  recover ' 
and  Judge  Porter  remarks  that  the  agent  is  not  responsible 
"  if  the  error  was  one  into  which  a  prudent  man  might  have 
fallen.  The  contrary  doctrine  seems  to  suppose  the  posses- 
sion, and  requires  the  exercise  of  perfect  wisdom.  No  man 
would  undertake  to  render  a  service  to  another  on  such 
severe  condition." 

If,  however,  an  unusual  and  violent  remedy  has  been 
administered  by  a  person  grossly  ignorant  of  medicine,  and 
this  medicine  has  caused  death,  if  the  individual  is  of  average 
mental  capacity  he  should  be  held  criminally  responsible, 
since  such  a  course  would  seem  to  imply  malice  on  his 
part. 

According  to  the  civil  law,  when  the  practice  of  the 
attending  physician  or  surgeon  is  called  in  question,  the 
prosecution  must  show,  first  that  the  injury  to  the  health  ] 
or  body  of  the  patient  actually  resulted  from  the  bad  treat- 
ment of  the  practitioner  ;  and,  secondly,  that  this  evil  result 
might  certainly  have  been  foreseen  and  avoided  by  a 
competent  medical  attendant.  "  Malpractice  can  only  be 
affirmed  when  the  practitioner  has  set  aside  estabHshed  prin- 
ciples, and  neglected  to  employ  means  which  are  universally 
held  to  be  necessary  in  the  given  case."  But  before  guilt 
can  be  established  on  any  such  derivation  it  must  be  shown 
(i)  that  the  following  out  of  the  rules  usually  prescribed 
by  medical  science  for  the  cure  of  disease  never  proves  detri- 
mental ;  (2)  that  there  is  at  least  the  greatest  probability 
that  the  observing  of  the  rules  would  accomplish  the  desired 
end ;  and  (3)  that  the  great  majority  of  medical  men  ap- 
prove the  rules. 

IV.  The  almost  universal  adoption  by  modern  surgeons 
31 


370  MEDICAL   JURISPRUDENCE. 

and  gynecologists  of  antiseptic  or  aseptic  methods  in  their 
practice  might  be  likely  to  raise  the  question  of  malpractice 
in  a  case  in  which  fatal  results  had  followed  an  operation  in 
which  antisepsis  had  been  neglected.  The  possibility  of 
such  a  contingency  should,  we  think,  serve  as  a  sufficient 
warning  to  the  operator  not  to  neglect  such  precautionary 
measures. 

V.  A  medical  man  cannot  be  held  guilty  of  criminal  care- 
lessness for  failing  to  employ  any  particular  remedy,  since 
there  is  never  any  one  remedy  upon  which  all  authorities 
are  agreed  ;  and  since  it  is  always  possible  that  the  patient 
may  recover  without  the  use  of  such  remedy.  If  it  could 
be  shown  that  there  existed  a  specific  remedy  for  any  dis- 
ease, then  a  neglect  to  use  such  remedy,  on  the  part  of  the 
physician,  would  be  criminal,  and  be  punished  as  such. 
The  uncertainty  of  remedies  must  necessarily  allow  a  large 
latitude  in  their  selection  and  employment ;  and  this  uncer- 
tainty even  affects,  to  some  limited  extent,  the  use  of  anti- 
dotes in  cases  of  poisoning.  But  where  it  can  be  shown 
that  a  physician  called  to  treat  a  case  of  poisoning  failed  to 
administer  the  universally  accepted  antidote,  he  should  be 
held  guilty  of  criminal  carelessness,  as,  e.g.,  albumin,  in  case 
of  corrosive  sublimate  poisoning. 

Casper  goes  further  than  this,  and  asserts  that  "  a  physi- 
cian should  be  held  liable  to  punishment  if,  in  a  given  case, 
he  departs  entirely  from  the  treatment  which  the  great 
majority  of  physicians  of  his  time  adopt,  and  which  the 
great  majority  of  medical  authorities  recommend  in  such 
cases."  But  great  difficulty  would  unavoidably  result  from 
adhering  to  such  a  rule  ;  it  might  often  be  impossible  for 
the  physician  to  stop  to  inquire,  in  any  given  case,  what 
was  the  practice  of  the   majority    of  his  contemporaries. 


MALPRACTICE.  3/1 

Besides,  this  principle  would  render  all  homeopaths,  eclec- 
tics, botanies,  etc.,  liable  to  punishment. 

In  consequence  of  these  doubts,  the  modern  practice  in 
the  United  States  is  that  when  a  physician  announces  him- 
self as  practising  under  some  particular  system,  as  the 
homeopathic,  eclectic,  or  botanic,  and  is  employed  by  per- 
sons knowing  that  this  is  the  case,  he  is,  at  least,  not  crimi- 
nally responsible  to  them,  in  the  event  of  serious  results, 
because  his  views  do  not  accord  with  those  of  what  are 
called  regular  practitioners.  While  the  law  prescribes  no 
one  absolute  system  of  medicine,  a  practitioner  is  expected 
to  practice  according  to  the  system  he  professes  and  avows  ; 
a.  departure  from  this  system,  if  accompanied  with  some 
serious  or  fatal  mistake  of  remedy,  would  render  him  justly 
amenable  to  a  criminal  charge.  Hence  a  regular  practi- 
tioner, and  one  employed  as  such,  if  he  should  surrepti- 
tiously, and  without  the  patient's  consent,  use  homeopathic 
or  botanic  treatment,  to  the  detriment  of  his  patient,  would 
clearly  be  liable  for  damages  to  the  latter ;  and,  moreover, 
he  could  not  recover  his  compensation  for  attendance,  in  a 
suit  at  law,  because  he  had  departed  from  his  avowed 
system  of  practice.  For  the  same  reason  a  homeopathic  or 
botanic  physician,  practicing  either  of  these  systems  avow- 
edly, if  he  should  have  employed  the  regular  system,  instead 
of  his  own,  and  his  patient  failed  to  make  a  good  recovery, 
would  equally  be  held  liable  for  damages,  and  would  equally 
be  exposed  to  a  non-suit  in  an  attempt  to  collect  his  fee,  in 
a  civil  court. 

The  civil  suits  for  alleged  malpractice  far  outnumber  the 
criminal  actions.  As  already  observed,  the  former  are  so 
alarmingly  frequent  as  to  occasion  a  general  distrust,  par- 
ticularly among  surgeons.     A  large  number  of  such  suits 


372  MEDICAL   JURISPRUDENCE. 

are  brought  evidently  for  the  purpose  of  blackmail  —  plaintiff 
being  usually  in  league  with  some  lawyer,  with  whom  he 
has  agreed  to  share  the  fees  ;  and  he  resorts  to  this  practice 
as  a  convenient  mode  of  discharging  his  doctor's  bill. 
Generally  speaking,  the  discrimination  of  the  court  is  ade- 
quate to  detect  and  expose  the  fraud,  even  to  a  jury,  which 
is  often  too  ready  to  side  with  the  plaintiff  in  a  trial  of  this 
nature. 

It  is  a  question  whether  a  slight  deviation  from  the  ordi- 
nary modes  of  performing  operations  should  involve  a 
charge  of  malpraxis.  Taylor  refers  to  a  remarkable  case 
occurring  in  this  country,  in  which  an  action  was  brought 
and  damages  recovered  against  a  physician  for  alleged  neg- 
ligence in  vaccinating  a  young  woman.  Some  inflamma- 
tion followed  the  operation,  which,  it  was  asserted,  was 
performed  nearer  the  elbow  joint  than  usual.  The  judge, 
singularly  enough,  ruled  that  "  the  physician  is  liable  for 
all  the  bad  consequences  resulting  from  vaccination  or 
inoculation,  if  he  fails  to  insert  the  virus  in  that  part  of  the 
arm  usually  selected  for  the  purpose,  notwithstanding  many 
other  parts  of  the  body  might  be  proved  to  be  equally 
proper  and  even  more  suitable  locations!"  Taylor  calls 
this  "a  very  singular  specimen  of  transatlantic  jurispru- 
dence." 

Gratuitous  service  on  the  part  of  the  practitioner  will  not 
exempt  him  from  an  action  for  malpractice,  if  either  ignor- 
ance or  carelessness  in  his  attendance  can  be  proven  against 
him. 

A  patient  who  refuses  to  cooperate  with  his  medical 
attendant,  and  who  thereby  sustains  injury,  cannot  recover 
compensation  for  the  injury,  unless  the  latter  is  clearly 
traceable  to  the  attendant's  malpractice. 


MALPRACTICE.  373 

It  has  lately  been  decided  that  when  a  physician  took 
with  him,  without  necessity,  to  a  case  of  confinement,  a 
young  unmarried  man  not  a  physician  nor  student  of  medi- 
cine, and  the  fact  of  his  not  being  a  medical  man  was 
unknown  to  the  patient  or  her  husband,  both  the  physician 
and  the  attendant  were  liable  for  damages. 

There  is  another  source  of  liability  to  an  action  for  mal- 
practice, which  is  not  generally  alluded  to,  but  which  from 
its  gravity  certainly  deserves  notice — viz.,  inebriety.  Most 
assuredly,  if  a  physician  or  a  surgeon,  when  inebriated, 
undertakes  to  prescribe  for  a  patient,  or  to  operate  upon 
him,  he  places  _  the  latter  in  serious  and  possibly  fatal 
jeopardy  ;  and  for  this  he  should  undoubtedly  be  held  re- 
sponsible. Many  States  have  enacted  statutory  laws  upon 
this  subject.  These  laws  vary  somewhat  in  the  severity  of 
the  punishment  annexed  to  the  offense. 

It  is  worth  while  noting  that  it  has  been  decided  by  one 
of  the  courts  that  to  enable  a  physician  to  recover,  by  suit, 
fees  for  services,  the  record  of  such  services  must  be  kept 
in  an  intelligent  form  and  in  a  regular  book.  Cabalistic 
signs  indicating  visits,  office  consultations,  etc.,  are  not  evi- 
dence. 

The  liability  of  druggists  rests  practically  upon  the  same 
principles  that  govern  physicians.  Ignorance  and  careless- 
ness in  putting  up  prescriptions,  whereby  gross  or  even 
fatal  mistakes  may  occur,  should  justly  render  them  hable 
to  an  action  at  law.  So,  likewise,  the  entrusting  the  com- 
pounding or  vending  of  medicines  to  careless  clerks  or 
inexperienced  apprentices  would  entail  criminal  responsi- 
bility upon  the  principal. 

There  is  a  special  law  in  some  States  in  relation  to  the 


374  MEDICAL   JURISPRUDENCE. 

selling  of  poisons  by  the  apothecary  without  a  physician's 
prescription  ;  and  also  regarding  the  proper  labeling  of  the 
same  before  sending  them  away. 

One  authority  states  :  "  Druggists,  like  physicians,  come 
under  the  laws  governing  specialists.  They  are  bound  to 
know  —  expected  to  know  —  the  kinds  and  natures  of  the 
medicines  with  which  they  deal.  ...  If  an  apothecary 
administers  improper  medicines,  the  law  holds  him  liable, 
although  his  contract  is  with  a  third  person." 

Another  authority  says  :  "  A  druggist  deals  in  things 
certain  —  things  which  his  eyes  can  see  and  his  hands  can 
handle.  He,  like  the  physician,  is  liable  for  ordinary  care 
and  skill ;  and  it  is  only  ordinary  for  a  druggist  to  know  of 
every  medicine  in  his  shop  and  to  have  his  medicines  in 
their  proper  places  and  properly  labeled." 

A  few  States  have  legislated  in  relation  to  the  mistakes 
made  by  druggists  and  their  clerks  in  the  compounding  of 
prescriptions,  the  penalties  affixed  being  regulated  by  the 
amount  of  damage  done  ;  if  death  resulted,  it  is  regarded  as 
a  felony  and  punished  by  a  heavy  fine  and  imprisonment. 
Doubtless,  however,  the  punishment  would  be  much  milder, 
provided  the  culprit  could  prove  a  previous  good  character 
as  to  "competency  and  skill,"  and  that  he  has  come  fully 
up  to  what  the  law  terms,  "  a  duly  qualified  assistant."  In 
the  latter  case,  his  mistake,  even  though  attended  with  fatal 
consequences,  would  probably  not  be  regarded  legally  as 
"culpable  negligence,"  but  would  rather  come  under  the 
head  of  "  excusable  homicide,"  or  "  homicide  by  misadven- 
ture," where  there  was  no  evil  intention  on  the  part  of  the 
perpetrator,  but  where  the  mistake  was  made  "  under  cir- 
cumstances of  sudden  confusion,  which  threw  him  off"  his 
guard." 


MALPRACTICE. 


375 


The  means  of  diagnosis  in  certain  classes  of  cases  have 
been  so  materially  increased  by  the  introduction  of  X-ray 
methods  that  it  is  obvious  that  charges  of  malpractice  may 
now  be  easily  sustained  in  cases  in  which  in  former  years 
no  such  liability  would  have  been  incurred.  It  is  as  yet 
uncertain,  however,  how  far  the  courts  will  hold  the  appli- 
cation of  these  methods  to  be  necessary,  or  admit  the  evi- 
dence that  is  thereby  obtained.  It  is  also  obvious  that  the 
various  tests  for  diagnostic  purposes  will,  in  time,  be  an  im- 
portant factor  in  questions  of  malpractice,  but  nothing  defi- 
nite can  be  given  at  present. 


CHAPTER    XV. 

LIFE    INSURANCE. 

Insurance  on  a  Life  is  simply  a  contract  whereby  the 
company  that  insures,  in  consideration  of  a  certain  sum, 
payable  in  instalments  and  denominated  a  premium,  agrees 
to  pay  a  stipulated  amount  at  the  death  to  the  heirs  or  to  a 
designated  person,  or  to  the  insured  himself  at  some  definite 
period  of  his  life.  The  deed  by  which  this  contract  is  made 
is  termed  a  policy.  This  policy  contains  many  provisions 
and  conditions,  upon  the  proper  construction  of  which  legal 
disputes  frequently  arise. 

The  amount  of  premium  to  be  paid  depends  chiefly  upon 
the  age  of  the  applicant,  though  also  somewhat  upon  the 
sex  and  occupation. 

The  amount  insured  for  (if  payable  at  death)  cannot  be 
recovered  until  distinct  and  satisfactory  proof  of  death  be 
furnished  by  the  beneficiary  of  the  policy.  Upon  this  proof 
the  companies  insist  with  great  positiveness,  inasmuch  as 
fraudulent  insurances  are  frequently  effected  and  the  com- 
panies victimized. 

In  case  of  mysterious  disappearance  of  the  insured,  with 
no  clew  to  his  whereabouts,  the  law  allows  an  interval  of 
seven  years  to  elapse  (presumption  of  death)  before  pay- 
ment can  be  pressed ;  but  it  is  usual  for  the  company  to 
make  the  payment  much  before  this  period,  unless  there  is 
good  reason  to  suspect  fraud.  This  is  especially  true  of 
persons  going  to  sea,  where  the  presumption  of  death  may 
be   settled    sooner.     Again,  the    question   of  survivorship 

376 


LIFE    INSURANCE.  'ij'J'J 

may  be  raised,  as  when  two  or  more  persons  perish  by  the 
same  calamity  —  as  by  shipwreck  —  and  one  happens  to  be 
insured  for  the  benefit  of  the  other. 

Among  the  conditions  of  a  policy,  the  most  important 
one  is  the  general  health  of  the  applicant,  as  influencing  his 
expectation  of  life ;  and  it  is  just  here  that  medical  science 
is  always  appealed  to  to  decide  upon  the  actual  condition 
and  the  proclivities  to  disease  through  hereditary  or  other 
causes.  The  printed  questions  in  the  policy  are  both 
numerous  and  pointed,  and  they  should  be  answered  truth- 
fully, since  the  contract  is  equally  binding  upon  the  insured 
as  upon  the  company ;  and  if  it  be  subsequently  discovered 
that  any  fraud  has  been  perpetrated  through  misrepresenta- 
tion or  concealment  of  facts  in  relation  to  disease  or  bad 
habits,  the  policy  will  be  voidable  and  the  premiums  already 
paid  forfeited.  This  is  just  and  equitable  ;  and  no  respect- 
able company  refuses  to  pay  the  amount  of  a  policy,  unless 
there  is  a  reasonable  ground  to  suspect  a  willful  fraud  in 
the  contract. 

Still,  lawsuits  occur  very  frequently  in  regard  to  life  in- 
surance, and  the  contested  points  usually  have  reference  to 
the  significance  of  medical  terms  or  phrases  in  the  contract, 
such  as  "any  other  diseases  or  habits  tending  to  shorten 
life,"  etc.  It  is  surprising  how  often  the  applicants  will 
prevaricate  and  dissimulate  upon  these  last-named  points, 
and  especially  upon  their  habits  as  regards  the  use  of  alco- 
holic drinks.  Medical  examiners  for  life  insurance  com- 
panies find  it  difficult  to  get  clear  and  satisfactory  answers 
in  relation  to  the  habits  of  the  individual  as  regards  the 
use  of  alcoholic  beverages.  Often  will  it  be  found  that  the 
man  who  is  in  the  habit  of  taking  three  or  four  drinks 
of  spirits  daily  will  consider  himself  a  perfectly  temperate 
32 


3/8  MEDICAL    JURISPRUDENCE. 

man  ;  and,  unless  he  is  closely  questioned  and  made  to  give 
distinct  replies,  he  may  be  classed  in  the  policy  as  strictly 
temperate,  when  all  the  while  his  health  is  undoubtedly 
being  undermined  and  his  expectation  of  life  thereby 
shortened,  although  he  cannot  properly  be  classed  as  an 
inebriate. 

The  suppression  of  a  fact  in  relation  to  the  health  of  the 
applicant,  if  not  known  by  him,  will  not  invalidate  his 
policy.  This  was  determined  in  a  case  in  which  Dr.  Reese 
was  an  expert  witness,  decided  on  an  appeal  to  the  United 
States  Supreme  Court  in  1880.  Here,  the  main  defense 
was  that  some  of  the  answers  to  the  interrogatories  of  the 
policy  were  not  true,  but  that  the  insured  was,  at  that  time, 
actually  suffering  from  certain  alleged  diseases  mentioned 
in  the  contract.  There  was  only  one  witness  to  support 
this  allegation,  a  homeopathic  physician,  who  had  prescribed 
for  the  plaintiff  thirteen  years  before  "for  chronic  asthma, 
manifestations  of  the  first  stages  of  consumption,  and 
scrofula."  This  witness,  as  it  appears,  never  mentioned 
his  suspicions  to  his  patient,  neither  did  he  testify  positively 
that  the  patient  really  had  the  diseases  for  which  he  treated 
him  ;  and,  moreover,  the  testimony  of  the  insured  was  that 
"  he  never  learned  from  him,  nor  from  any  other  physician, 
nor  had  he  ever  suspected,  nor  had  the  remotest  idea,  that 
he  was  affected  with  any  such  diseases  ;  but,  on  the  contrary, 
he  always  boasted  of  himself  as  being  a  strong,  healthy,  and 
robust  man."  Clearly,  in  such  a  case,  the  applicant  should 
not  be  held  responsible  for  the  suppression  of  a  fact  of 
which  he  was  utterly  ignorant  and  of  the  very  existence  of 
which  there  was  considerable  doubt. 

In  all  cases  the  exact  state  of  the  applicant's  bodily  health 
should  be  ascertained,  either  by  his  answers  to  the  written 


LIFE    INSURANCE.  379 

categorical  questions,  or  by  oral  questioning  by  the  medical 
examiner.  The  case  of  the  Duke  of  Saxe  Gotha  is  cited  as 
an  illustration  of  the  necessity  of  not  concealing  material 
facts.  The  applicant,  while  residing  abroad,  was  insured  in 
an  English  office  for  the  sum  of  ;^3,ooo.  The  certificates 
of  his  two  German  medical  examiners  stated  that  his  gen- 
eral health  was  good,  although  he  had  an  impediment  in 
his  speech  and  an  affection  in  one  eye,  but  that  he  was 
perfectly  free  from  disease  or  symptoms  of  disease.  The 
facts  were  that  the  Duke  had  been  suffering  from  cerebral 
disorders  for  over  two  years,  that  he  was  childish  and  could 
not  speak.  He  died  of  paralysis  within  nine  months  after- 
ward and  an  autopsy  disclosed  a  large  tumor,  evidently  of 
long  standing,  pressing  upon  the  brain  together  with  an 
effusion  of  ten  ounces  of  serum.  The  plaintiff  was  non- 
suited. 

The  question  of  intemperance  in  relation  to  the  habits  of 
the  insured  causes,  probably,  more  discussion  and  difference 
of  opinion  in  contested  life-insurance  cases  than  any  other. 
It  would  seem  almost  impossible  in  such  cases  to  define 
what  intemperance  is.  An  instance  is  mentioned  by  Taylor 
which  illustrates  the  difficulty  of  getting  at  the  truth.  "In 
this,  payment  was  refused  on  the  ground  of  concealed  habits 
of  intemperance.  Twelve  witness  were  called  by  the 
plaintiff  to  prove  that  the  deceased  was  a  very  temperate 
man,  while  the  office  called  twenty-one  to  show  that  he  was 
habitually  intemperate.  The  medical  man  who  furnished 
the  certificate  stated  that  he  considered  it  a  perfectly  safe 
risk  ;  for,  although  he  had  occasional  outbreaks,  he  did  not 
think  drinking  had  any  bad  effects  upon  his  health.  This 
case  shows  the  differing  views  entertained  by  even  medical 
men  upon  this  subject. 


380  MEDICAL   JURISPRUDENCE. 

While  we  must  admit  that  there  are  a  few  exceptional 
cases  of  persons  who  are  habitual  moderate  drinkers  living 
to  old  age,  and  enjoying  apparent  uninterrupted  health,  we 
cannot  be  blind  to  the  fact  that  habitual  drinking  does  cer- 
tainly and  gradually  impair  the  health,  inducing  dropsy  and 
organic  disease  of  the  stomach,  liver,  and  kidneys,  which 
unquestionably  tend  to  shorten  life. 

If  a  true  representation  of  the  temperate  habits  of  the 
insured  was  made  at  the  time  of  application,  and  he  should 
subsequently  fall  into  habits  of  intemperance,  this  would  be 
no  bar  to  a  recoveiy  upon  the  policy.  In  many  of  the 
modern  policies  the  proviso  against  intemperance  is  omitted. 

The  above  general  principles  will  serve  also  as  a  guide  in 
cases  of  the  opium  or  chloral  habit.  A  concealment  of  the 
fact  that  the  applicant  was  addicted  to  opium  eating,  even 
although  it  might  be  alleged  that  this  habit  had  not  im- 
paired his  health,  would  undoubtedly  be  an  obstacle  to  a 
recovery  upon  the  policy. 

As  regards  the  question  whether  insanity  has  a  tendency 
to  shorten  life,  and  therefore  whether  the  concealment  of 
its  existence  in  the  applicant  amounts  to  the  concealment 
of  a  material  fact,  it  may  be  said  the  almost  uniform  expe- 
rience of  physicians  is  that  it  does  tend  to  shorten  life. 
Moreover,  there  is  in  nearly  every  policy  a  direct  question 
bearing  upon  this  point,  the  company  reserving  to  itself  the 
right  to  reject  the  particular  applicant  thus  affected. 

The  relationship  of  suicide  to  life  insurance  is  one  of  con- 
siderable interest,  and  has  been  the  source  of  frequent  liti- 
gations. The  principle  by  which  any  particular  case  is  to 
be  decided  is  —  Was  the  suicide  evidently  the  result  of  in- 
sanity, and  did  this  insanity  come  on  after  the  policy  was 
taken  out  ?     If  so,  then  clearly  the  insured  is  entitled  to 


LIFE    INSURANCE.  38  I 

recover,  just  as  much  so  as  if  the  suicide  was  caused  by  the 
acute  delirium  of  a  fever,  or  by  inflammation  of  the  brain. 
But  if  it  can  be  shown  that  the  suicide  was  the  result  of 
a  deliberately  formed  purpose,  with  a  motive  sufficiently 
strong  to  impel  to  the  act  (such  as  to  get  rid  of  impending 
debts,  or  to  bestow  the  insurance  money  upon  the  indi-  J 
vidual's  family),  then  there  was  no  insanity  connected  with 
the  act,  and  the  policy  should  be  void,  because  the  insured 
had  voluntarily  shortened  his  Hfe.  In  a  doubtful  case  of 
this  character,  the  turning-point  would  seem  to  be  to  deter- 
mine if  the  suicide  could  be  traced  to  a  perfectly  intelligent 
motive.  For  example :  It  is  credible  that  an  individual 
pressed  down  by  the  burden  of  some  enormous  debt,  which 
he  has  been  vainly  hoping  to  pay,  and  with  the  poverty  and 
degradation  of  his  family  staring  him  in  the  face,  should 
embrace  a  tempting  offer  to  insure  his  life  for  an  amount 
that  will  not  only  repay  his  indebtedness  and  rescue  his 
name  from  dishonor,  but  at  the  same  time  save  from  poverty 
and  want  those  whom  he  loves  better  than  himself  Why 
should  not  the  spirit  of  self-sacrifice  be  as  dominant  in  such 
a  one  as  in  the  embezzler  who,  to  avoid  the  discovery  of 
his  frauds  and  the  disgrace  and  punishment  consequent 
thereupon,  voluntarily  takes  his  own  life?  Avery  suspi- 
cious circumstance  in  connection  with  these  cases  of  suicide 
and  life  insurance  is  the  fact  that  the  deceased  has  rarely 
made  more  than  one  or  two  payments  on  his  premium 
before  committing  the  suicidal  act. 

One  of  the  most  remarkable  cases  of  this  character,  in 
which  the  question  of  suicide  by  strangulation  was  urged 
by  the  defense,  is  that  of  Col.  Dwight,  which  was  tried  in 
Norwich,  N.  Y.,  in  December,  1883.  This  gentleman  had 
been  involved  in  heavy  pecuniary  difficulties,  through  ex- 


382  MEDICAL   JURISPRUDENCE, 

tensive  financial  operations.  A  few  months  before  his  death 
he  effected  insurances  on  his  hfe  to  the  amount  of  three 
hundred  thousand  dollars,  on  which  he  had  made  one  quar- 
ter's payment  before  he  died.  He  had  been  complaining 
some  weeks  before  of  chills,  loss  of  appetite,  and  sleepless- 
ness ;  but  on  the  day  of  his  death  he  was  comfortable,  was 
up  and  dressed,  saw  company,  and  executed  legal  papers. 
About  half-past  eleven  o'clock  on  that  night  he  was  heard 
to  gasp  for  breath  by  his  attendant,  who  was  in  an  adjoin- 
ing room  ;  he  immediately  went  to  his  aid,  raising  him  up, 
and  then  summoned  his  wife  and  other  friends ;  death 
occurred  almost  immediately  afterward.  The  question  to 
determine  was  whether  deceased  had  strangled  himself 
with  a  cord,  or  whether  the  death  had  resulted  from  an 
overdose  of  morphin,  of  which  he  had  taken  about  three 
grains  throughout  that  day  by  the  advice  of  his  physician. 
To  support  the  theory  of  suicide  by  strangulation,  several 
highly  respectable  physicians  testified  to  the  presence  of 
one  or  more  distinct  depressions  around  the  neck,  having 
all  the  characters  attendant  on  the  usual  marks  of  a  con- 
stricting cord.  These  marks  were  attempted  to  be  ex- 
plained away  by  attributing  them  to  the  folds  of  the  skin  of 
the  neck  due  to  the  bending  of  the  neck  in  the  ice-box. 
But  they  were  also  noticed  several  months  later,  on  the 
exhumation  of  the  body.  On  the  side  of  the  plaintiff,  it 
was  alleged  that  the  death  was  due  to  heart  exhaustion, 
precipitated  by  the  overdose  of  morphin.  No  testimony, 
singular  to  say,  was  taken  from  the  persons  who  were  wit- 
nesses of  the  death,  save  the  one  who  sat  up  with  him,  and 
this  man  said  nothing  about  strangulation,  but  gave  the 
idea  of  its  being  a  natural  death.  The  jury  found  for  the 
plaintiff,  thus  ignoring    the  idea  of  a  fraudulent   suicide. 


LIFE    INSURANCE.  383 

The  insurance  companies  appealed,  and  after  trials  in  sev- 
eral courts  the  case  was  compromised. 

A  decision  has  recently  been  made  by  the  United  States 
Supreme  Court  declaring  that  when  a  person  of  sound  mind 
commits  suicide  the  life  insurance  becomes  void. 


CHAPTER  XVI. 

TOXICOLOGY. 

Poisoning  is  probably  the  most  frequent  of  all  the  causes 
of  violent  death,  the  casualties  of  war  excepted.  The  fa- 
cility with  which  poisons  may  be  procured,  the  ease  with 
which  they  can  be  administered,  and  the  close  resemblance 
that  the  effects  of  many  of  them  bear  to  disease  in  symp- 
toms and  post-mortem  lesions,  will  account  for  the  fact  of 
their  extensive  employment,  both  for  homicidal  and  suicidal 
purposes. 

A  poison  may  be  defined  to  be  a  substance  that  when  ab- 
sorbed into  the  system  produces  such  a  disturbance  of  func- 
tion as  to  imperil  life.  Mere  mechanical  action  such  as  that 
produced  by  powdered  glass  would  not  be  included  by  this 
definition,  but  be  classified  under  traumatism.  Whether 
or  not  a  given  substance  acts  as  a  poison  depends,  among 
other  matters,  upon  the  dose  taken.  Strychnin  is  uni- 
versally regarded  as  a  poison,  but  in  very  small  doses  {^^ 
grain)  it  may  be  taken  daily  for  long  periods  without  ap- 
parent injury  and  is,  indeed,  regarded  as  a  tonic. 

According  to  the  above  definition,  it  matters  not  by  what 
avenue  a  poison  gains  access  into  the  body,  its  ultimate 
effects  are  the  same.  The  stomach,  of  course,  is  the  most 
usual  means ;  but  the  rectum,  the  skin,  the  lungs,  and  the 
cellular  tissue  by  hypodermic  injection,  and  even  the  nose, 
ear,  and  vagina,  are  also  channels  of  entrance.  Inhalation 
of  poisonous  vapors  through  the  lungs,  and  the  subcutane- 
ous introduction  by  the  hypodermic  syringe  affect  the  system 

384 


ACTION    OF    POISONS.  385 

far  more  rapidly  than  by  swallowing,  because  of  their  more 
rapid  absorption. 

The  Effects  of  Poisons  are  local  and  remote.  The 
local  effects  are  the  direct  impressions  produced  on  the  part 
of  the  body  with  which  the  poison  comes  into  contact  —  e.  g., 
the  corrosion  of  the  stomach  and  bowels  by  the  immediate 
contact  of  the  mineral  acids  and  alkalies.  Often  a  poison 
may  act  both  locally,  by  its  causing  inflammation  of  the 
stomach,  and  also  remotely,  on  the  brain  and  nervous  sys- 
tem. 

The  remote  effects  of  a  poison  are  those  results  which 
are  produced  on  parts  of  the  system  remote  from  that  to 
which  it  was  first  appHed,  as,  e.  g.,  the  narcotic  effects  of 
opium  on  the  brain,  after  being  taken  into  the  stomach. 
These  remote  effects  constitute,  in  fact,  the  usual  symp- 
toms of  poisoning  —  a  very  important  factor  in  the  diagnosis 
of  the  case. 

Mode  of  Action  of  Poisons.  —  In  order  that  a  poison 
should  produce  its  full  effects  on  the  system,  it  is  necessary 
that  it  should  get  into  the  circulation,  so  as  to  be  conveyed 
to  distant  parts  of  the  body ;  and  for  this  purpose  it  must 
first  be  absorbed.  Although  other  modes  of  transfer  of  the 
poisonous  impression  to  remote  parts  of  the  system  have 
been  at  various  times  recognized,  —  such  as  nervous  com- 
munication and  contiguity  of  structure,  —  the  present  ac- 
cepted doctrine  is  that  of  absorption  into  the  circulation. 
The  so-called  corrosives  produce  local  actions  that  are  gen- 
erally sufficient  to  produce  death. 

The  proofs  of  absorption  are  abundantly  afforded  (i)  by 
the  detection  of  the  known  poisons  in  the  blood ;  (2)  in  the 


386  TOXICOLOGY. 

secretions,  especially  the  urine  ;  and  (3)  in  the  different 
viscera  of  the  body,  as  the  liver,  kidneys,  lungs,  spleen, 
brain,  etc.  An  essential  part  of  the  toxicological  examina- 
tion is  to  discover  the  poison,  in  the  absorbed  state,  in  the 
viscera. 

The  rapidity  of  the  absorption  is  remarkable.  It  has 
been  shown  that  a  poison  injected  hypodermically  will  be 
diffused  through  the  circulation  in  a  few  seconds,  A  solu- 
tion of  hydrogen  sulphid  injected  into  the  rectum  of  a  dog 
was  eliminated  by  the  lungs  in  sixty-five  seconds. 

The  rapidity  of  absorption  is  materially  influenced  (i)  by 
the  solubility  of  the  poison  ;  so  long  as  the  substance  is 
insoluble  it  cannot  be  absorbed,  but  many  substances 
insoluble  in  water  speedily  dissolve  in  the  fluids  of  the 
stomach  and  intestines,  and  so  pass  into  the  circulation. 
(2)  By  the  nature  of  the  surface  to  which  it  is  applied,  it 
being  in  direct  ratio  to  the  vascularity  of  the  part.  It  is  for 
this  reason  that  the  most  rapid  absorption  is  from  the  air- 
cells  of  the  lungs,  when  the  substance  is  inhaled  in  the  form 
of  vapor,  and  is  immediately  taken  up  by  the  very  extended 
vascular  pulmonary  area.  For  this  same  reason,  also,  when 
it  is  injected  directly  into  the  blood-vessels,  the  effect  is 
almost  instantaneous.  Christison  injected  conin  hydro- 
chlorid  into  the  femoral  vein  of  a  dog,  and  death  took  place 
in  three  or  four  seconds.  Some  animal  poisons,  such  as 
the  virus  of  glanders,  syphilis,  smallpox,  etc.,  when  swal- 
lowed, appear  to  undergo  a  change,  through  digestion, 
which  renders  them  innocuous.  The  absorption  of  poisons 
in  the  stomach  is  modified  by  the  condition  of  that  organ 
—  being  most  rapid  when  it  is  empty.  The  skin  may  be 
the  avenue  for  the  introduction  of  poisons,  as  witnessed  in 
the  absorption  of  arsenic,  tartar  emetic,  corrosive  sublimate, 


DISPOSITION    OF    THE    POISONS.  38/ 

opium,  etc.,  when  applied  in  ointment  or  washes.  By 
removing  the  cuticle,  the  absorption  is  much  more  rapid, 
as  seen  in  the  endermic  method.  (3)  Fullness  of  the  blood- 
vessels. The  rapidity  of  absorption  is  inversely  to  the 
quantity  of  the  circulating  fluid  ;  hence,  depletion  by  bleed- 
ing or  purging  will  favor  absorption. 

But  admitting  the  fact  of  absorption,  the  further  question 
whether  the  fatal  effects  of  the  poison  are  to  be  ascribed  to 
this,  is  answered  affirmatively  by  showing  that  these  effects 
continue  so  long  as  the  circulation  of  the  blood  goes  on 
between  the  point  of  insertion  and  the  organs  affected,  and 
that  they  cease  when  the  circulation  is  arrested.  The  oft- 
quoted  experiment  of  Magendie  establishes  the  first  of  these 
propositions.  He  divided  all  the  tissues  of  a  frog's  leg 
except  the  blood-vessels,  and  inserted  the  foot  into  a  solu- 
tion of  nux  vomica ;  absorption  took  place  through  the 
blood  and  fatal  tetanic  convulsions  ensued.  The  same 
experiment  repeated  on  a  leg  in  which  the  blood-vessels 
only  were  divided  (they  interrupting  the  circulation),  pro- 
duced no  effect  upon  the  animal.  The  second  proposition  is 
proved  both  by  the  foregoing  experiment,  and  in  the  fol- 
lowing :  Hydrogen  cyanid  was  introduced  into  the  stomach 
of  a  dog,  through  an  opening  in  its  walls.  So  long  as  the 
vessels  passing  from  the  stomach  to  the  liver  were  secured 
by  a  ligature,  no  poisonous  effects  were  produced ;  but 
they  were  manifested  within  one  minute  of  the  removal  of 
the  ligature. 

Subsequent  Disposition  of  the  Poison. — After  absorp- 
tion into  the  blood,  as  the  poison  passes  through  the  differ- 
ent organs,  a  portion  of  it  is  immediately  separated  by  these, 
and  at  once  eliminated  by  the  various  secretions,  bile,  urine. 


388  TOXICOLOGY. 

saliva,  pancreatic  fluid,  and  sweat.  Another  portion  may- 
be temporarily  deposited  in  the  organs  and  tissues,  and 
usually  in  the  following  order  as  to  quantity  :  the  liver, 
spleen,  kidneys,  heart,  lungs,  brain,  pancreas,  muscles,  and 
bones.  To  this  order  there  may  be  occasional  exceptions^ 
as  some  recent  experiments  seem  to  prove  that  lead  and 
certain  other  mineral  poisons  show  an  especial  affinity  for 
the  spinal  cord  and  brain.  Only  a  minute  quantity  of  the 
poison  is  circulating  in  the  capillaries  at  any  one  time,  yet 
there  is  good  reason  to  believe  that  it  is  exclusively  this 
small  portion  which  is  really  noxious  ;  while  still  remaining 
in  the  stomach,  or  retained  in  the  organs,  it  is  harmless. 
Hence,  it  is  a  common  mistake  to  attribute  death  to  the 
actual  quantity  of  the  poison  found  in  the  stomach  of  the 
deceased  ;  this  is  only  the  surplus,  or  complement,  of  what 
was  necessaiy  to  kill.  It  has,  in  fact,  no  direct  connection 
with  the  fatal  result,  this  being  caused  by  the  absorbed 
portion  only  (except  in  the  case  of  the  corrosives,  which 
act  locally).  Although  that  portion  of  the  poison  which  is 
retained  in  the  organs  (absorbed)  is,  for  the  time  being, 
innocuous,  yet,  as  it  is  liable  to  be  reabsorbed  into  the  circu- 
lation, it  may  again  prove  active.  Hence,  in  the  treatment  of 
a  case  of  poisoning,  the  importance  of  completely  eliminat- 
ing the  noxious  agent  from  the  system. 

While  we  have  no  positive  proof  that  all  poisons  are 
deposited  in  the  organs,  we  know  that  this  is  true  of  the 
mineral,  and  of  many  of  the  vegetable  poisons.  The  gaseous 
poisons  appear  to  be  eliminated  by  the  lungs  immediately, 
without  this  deposition.  This  was  proven  by  Bernard,  who 
injected  into  the  jugular  vein  of  a  dog  a  cubic  inch  of  water 
saturated  with  sulphuretted  hydrogen.  A  piece  of  paper, 
wetted  with  solution  of  lead  acetate,  was  held  to  the  dog's 


DISPOSITION    OF    THE    POISON.  389 

mouth.  It  blackened  in  from  three  to  five  seconds,  show- 
ing that  the  gas  had  been  eliminated  from  the  lungs.  This 
elimination  was  completed  in  a  few  seconds. 

The  time  required  for  an  absorbed  poison  to  be  removed 
from  the  circulation,  either  by  elimination  or  by  deposition 
in  the  organs  or  tissues,  varies  for  different  substances,  and 
also,  probably,  for  different  conditions  of  the  system.  Cer- 
tain medicinal  substances  are  known  to  appear  in  the  urine 
a  few  minutes  after  being  swallowed  —  e.  g.,  potassium  iodid 
and  turpentine.  In  relation  to  mineral  poisons,  there  is 
reason  to  believe  that  they  are  rapidly  separated  from  the 
blood.  Experiments  have  shown  that  arsenic  may  be  dif- 
fused throughout  the  body  of  an  animal  in  an  hour  and  a 
half  after  being  swallowed.  It  has  also  been  found  in 
the  urine  of  a  horse  within  one  hour  after  administration. 
Taylor  found  arsenic  in  the  human  liver  four  hours  after 
being  swallowed.  Doubtless  it  reaches  this  organ  much 
sooner  than  this,  although  no  opportunity  has  as  yet  been 
afforded  of  proving  the  fact,  since  death  rarely  occurs 
earlier  than  the  above  period.  Taylor  believes  that  the 
liver  acquires  its  maximum  of  saturation  by  arsenic  in  fifteen 
hours  after  the  ingestion  of  the  poison.  He  gives  a  table 
of  the  estimated  average  amount  of  this  poison  that  will  be 
found  in  this  organ  at  different  periods :  In  five  to  seven 
hours  after  taking,  the  quantity  is  0.8  grain;  in  nine  hours, 
1.2  grains;  in  fifteen  hours,  2.0  grains;  in  seventeen  to 
twenty  hours,  1.3  grains;  in  fourteen  days,  o.  I7  grain.  It 
is  generally  admitted  that  arsenic  is  entirely  eliminated  from 
the  human  system  in  about  fifteen  days,  but  cases  have 
been  reported  where  the  poison  was  detected  in  the  urine 
as  late  as  the  twenty-fifth  day.  As  a  rule,  the  analyst  need 
hardly  expect  to  find  any  traces  of  arsenic  in  the  body  of  a 
person  who  has  survived  fifteen  days._^after  swallowing  it. 


390  TOXICOLOGY. 

Other  mineral  poisons  require  a  longer  time  for  their 
elimination  from  the  human  body.  According  to  Orfila, 
arsenic  and  corrosive  sublimate  require  thirty  days ;  anti- 
mony, four  months  ;  silver,  five  months  ;  lead  and  copper, 
over  eight  months. 

This  doctrine  of  the  elimination  of  poisons  must  be  held 
with  some  reserve.  The  question  may  at  times  assume 
very  serious  importance.  Suppose  a  case  of  alleged  arsen- 
ical poisoning,  in  which  the  deceased  had  survived  two  or 
three  days,  but  in  which  the  toxicologic  examination  failed 
to  reveal  any  traces  of  the  poison  in  the  liver  or  other 
viscera.  Here,  the  defense  might  very  plausibly  urge  that 
the  death  was  not  caused  by  the  poison,  as  alleged,  inas- 
much as  it  could  not  be  found  in  the  viscera,  where  it  ought 
to  be  discovered  (according  to  authorities),  if  life  was  not 
protracted  beyond  fifteen  days.  There  must  be  exceptions 
to  the  above  rule,  as  m  a  case  in  which  there  had  been  ex- 
cessive vomiting  and  purging  from  the  first,  and  the  dose 
of  the  poison  comparatively  moderate.  Taylor  mentions  a 
case  of  this  nature,  in  which  arsenic  had  caused  death  in 
twenty-six  hours ;  there  had  been  much  vomiting  and  purg- 
ing, and,  on  examination,  the  poison  had  nearly  disappeared 
from  those  viscera  in  which  it  is  usually  found.  In  such  a 
case,  if  the  other  evidences  of  poisoning  were  present,  the 
negative  chemical  testimony  is  of  less  moment.  On  the 
other  hand,  a  case  may  present  itself  (as  it  has  to  the  author) 
in  which  a  person  who  has  been  taking  small  doses  of 
arsenic,  medicinally,  for  a  length  of  time,  dies  suddenly, 
with  gastro-enteric  symptoms  and  under  suspicious  circum- 
stances. Here,  an  examination  of  the  liver  may  discover 
traces  of  arsenic,  and  this  may  be  regarded  by  the  prosecu- 
tion as  proof  of  criminal  administration,  especially  if  it  could 


THE    MODE    OF    DEATH.  39 1 

be  shown  that  the  deceased  had  not  taken  the  medicine  for 
at  least  fifteen  (thirty)  days  before  death.  In  such  a  case, 
in  the  absence  of  all  the  other  factors  of  evidence,  the  find- 
ing of  traces  of  arsenic  in  the  liver,  within  the  period  of 
time  above  mentioned,  would  not  establish  it  as  the  cause 
of  death. 

The  Mode  of  Death  by  poisons  has  been  a  subject  of 
much  discussion.  It  must  be  admitted  that  we  are  not  in 
possession  of  the  full  knowledge  of  this  subject.  We  know 
that  the  various  poisons  circulate  through  the  blood,  and 
thus  come  in  contact  with  some  one  of  the  great  centers  of 
life  —  the  heart,  the  lungs,  and  the  brain  and  spinal  cord  — 
and  then  and  there  produce  their  specific  effects  ;  one,  on 
the  brain,  causing  narcotism  ;  another,  on  the  heart,  pro- 
ducing asthenia  ;  a  third,  acting  on  the  spinal  cord,  causing 
tetanus,  etc.  ;  but  why  they  possess  this  elective  affinity  for 
these  different  organs  we  are  unable  to  explain.  Neither 
do  we  understand  why  different  poisons  exhibit  a  similar 
election  in  their  modes  of  elimination  from  the  system,  e.  g:, 
potassium  iodid  passing  out,  by  preference,  through  the 
urine ;  mercuiy,  by  the  saliva ;  arsenic,  by  the  glands  of 
the  stomach,  etc. 

One  mode  in  which  death  occurs  by  poisoning  is  prob- 
ably by  shock  on  the  general  nervous  system,  as  seen  in 
the  case  of  the  powerful  corrosives  —  their  violent  local  ac- 
tion causing  a  general  depression  of  the  system  very  similar 
to  that  occasioned  by  a  severe  superficial  burn  or  other 
severe  injury.  Most  probably  there  is  some  histological  or 
pathological  change  produced  by  the  poison  in  the  organ 
or  tissue. 

The  fact  that  poisons  must  enter  the  circulation  before 


392  TOXICOLOGY. 

they  can  become  effective  naturally  suggests  the  idea  of 
some  chemical  or  other  change  produced  on  the  blood,  and 
possibly  on  the  poison  itself.  This,  however,  cannot  be 
proved.  As  regards  any  physical  alterations  of  the  blood 
corpuscles,  microscopic  examination  has  failed  as  yet  to 
discover  anything  that  can  be  regarded  as  conclusive, 
although  it  has  demonstrated  alteration  in  their  size,  shape, 
and  color,  in  the  case  of  certain  poisons. 

Modifying  Circumstances  connected  with  Poisons.  — 

Some  of  these  relate  to  the  poison  itself,  and  others  are 
connected  with  the  system.  Among  the  former,  the  dose 
and  mode  of  administration  require  notice.  As  a  rule,  the 
larger  the  dose,  the  more  speedy  the  action.  An  exception 
to  this  is  seen  in  the  case  of  some  irritants,  such  as  arsenic, 
where  a  large  dose  may  be  rejected  by  vomiting,  and  might 
thus  prove  innocuous,  while  a  smaller  one  would  be  re- 
tained. The  effect  of  some  poisons  is  much  modified  by 
the  dose ;  thus,  a  large  dose  of  oxalic  acid  kills  almost 
immediately  by  shock,  while  a  smaller  one  will  act  upon 
the  heart  and  nervous  centers,  and  prove  fatal  more 
slowly. 

The  effect  of  combinations  of  poisons  is  sometimes  to 
increase,  sometimes  to  diminish,  their  activity,  and  again, 
to  antagonize  or  neutralize  their  action.  According  to 
Christison,  the  effects  of  arsenic  are  decidedly  modified  by 
alcoholic  intoxication,  which  seems  in  some  way  to  arrest, 
or  suspend  its  action.  This  is  also  probably  true  of  other 
irritant  poisons.  The  same  authority  mentions  a  case  where 
a  very  large  dose  of  corrosive  sublimate  and  laudanum  was 
taken,  and  there  was  a  remarkable  postponement  of  all  the 
usual  symptoms. 


ANTAGONISM    OF    POISONS.  393 

Antagonism  of  Poisons. — That  an  antagonism  exists 
between  certain  poisons  —  the  one  neutralizing  the  effects  of 
the  other  in  the  animal  system  —  has  been  satisfactorily- 
demonstrated.  Experiments  on  frogs  go  to  prove  that  this 
antagonism  is  of  a  twofold  character  —  physiological  and 
toxic.  For  example,  calcium  salts  given  in  toxic  doses 
occasion  complete  ventricular  contraction  in  the  frog's 
heart,  the  animal  dying  with  the  heart  in  systole.  On  the 
other  hand,  potassium  salts  produce  relaxation  of  the  ven- 
tricle, and  death  occurs  in  diastole.  But  by  a  careful  equi- 
poise in  the  dose  of  these  two  salts  the  physiological  effects 
of  each  can  be  mutually  and  completely  controlled  and 
neutralized  by  the  other,  so  that  the  normal  action  of  the 
heart  is  restored,  and  the  animal  survives.  A  similar 
antagonism  has  been  found  to  exist  between  veratrin  and 
potassium  salts  —  the  alkaloid  here  acting  precisely  like  a 
calcium  salt  in  neutralizing  the  effects  of  the  potassium  salt. 

Hence  we  may  regard  the  action  of  antidotes  in  cases  of 
poisoning,  as  being  of  a  twofold  character — physiological 
and  chemical. 

This  question  of  antagonism  acquires  much  greater  in- 
terest and  importance  when  we  come  to  consider  its  bearing 
in  certain  cases  of  criminal  poisoning,  in  which,  in  the  ab- 
sence of  the  usual  chemical  and  other  recognized  proofs  of 
the  alleged  poison,  the  attempt  is  made  to  show  that  by  a 
combination  of  poisons  their  action  upon  the  human  sys- 
tem will  become  so  modified  as  to  conceal  the  symptoms, 
and  prevent  their  discovery  after  death  by  the  usual  chem- 
ical tests.  It  then  assumes  a  considerable  importance. 
This  doctrine  was  —  for  the  first  time,  apparently,  in  this 
country  —  urged  with  some  plausibility,  at  the  celebrated 
trial  of  Dr.  Paul  Schoeppe,  at  Carlisle,  Pa.,  in  1869.     After 

33 


394  TOXICOLOGY. 

the  failure  by  the  prosecution  to  establish  the  allegation  of 
poisoning  by  hydrogen  cyanid  (inasmuch  as  the  single 
symptoms  were  rather  those  of  apoplexy),  it  set  up  the 
claim  that  the  death  was  produced  by  a  mixture  of  hydro- 
gen cyanid  and  morphin,  and  ascribed  the  absence  of  all  the 
usual  symptoms  of  the  former,  and  the  failure  to  detect 
either  it  (except  by  the  merest  trace,  which  was  shown 
might  result  from  the  faulty  method  of  the  analysis)  or  the 
morphin,  to  the  alleged  antagonism  of  the  two  substances, 
although  there  was  not  the  slightest  evidence  of  the  admin- 
istration of  either.  In  the  year  1870  Dr.  Reese  made  a 
number  of  experiments  upon  dogs,  with  a  view  of  deter- 
mining this  question.  A  few  of  the  results  will  be  briefly 
detailed  here :  — 

1 .  Morphin  and  Hydrogen  Cyanid.  —  If  both  poisons  are 
given  in  full  lethal  doses,  the  symptoms  of  both  toxic 
agents  are  exhibited.  The  morphin  never  counteracts  the 
fatal  effects  of  the  other  body,  if  the  latter  be  taken  in  full 
poisonous  doses. 

2.  Morphin  and  Atropin.  —  A  mutually  antagonizing 
influence  of  these  two  alkaloids  is  not  distinctly  manifest  in 
dogs. 

3.  Stjychnin  and  Hydrogen  Cyanid. — These  powerful 
poisons  evince  no  real  antagonism.  When  both  were  taken 
in  full  doses,  the  usual  symptoms  of  each  were  exhibited 
alternately  —  convulsions  and  tetanic  spasms. 

4.  Strydmin  and  Morphin.  —  These  alkaloids  show  no 
disposition  to  antagonism  when  given  in  full  doses.  The 
narcotism  of  the  morphin  (taken  first)  was  speedily  followed 
by  the  tetanus  of  the  strychnin  (taken  afterward). 

5.  Atropin  and  Eserin.  —  The  investigations  of  Dr. 
Frazer  with   these  substances  on  dogs  demonstrate  a  real 


ANTAGONISM    OF    POISONS.  395 

antagonism,  which  was  confirmed  by  Dr.  Reese's  experi- 
ments. 

6.  Atropi?i  and  Strychnin.  —  There  would  seem  to  be  a 
true  antagonism  between  these  two  alkaloids,  sufficient  to 
justify  a  resort  to  the  use  of  atropin  in  a  case  of  strychnin- 
poisoning. 

There  also  appears  good  reason  for  admitting  the  antag- 
onism between  Aconite  and  Digitalis  —  sufficiently  so  to 
warrant  a  trial  of  digitalis  in  a  case  of  poisoning  by  aconite. 

The  conditions  of  the  system  that  modify  the  action  of 
poisons  are  habit,  idiosyncrasy,  and  disease.  Habit  usually 
diminishes  the  power  of  poisons,  as  shown  especially  in 
the  case  of  the  narcotics,  opium  and  alcohol.  It  is  also 
alleged  to  be  true  in  the  case  of  arsenic,  as  seen  in  the 
arsenic-eaters  of  Styria  and  other  mountainous  countries. 

The  effect  of  disease  in  modifying  the  action  of  poisons 
is  witnessed  in  the  tolerance  by  the  system  of  opium  in 
tetanus  and  mania-a-potu,  and  of  its  increased  susceptibility 
to  this  drug  in  apoplexy  and  inflammation  of  the  brain.  In 
paralysis,  the  susceptibility  to  the  action  of  strychnin  is 
diminished. 

The  influence  of  sleep  is  usually  to  diminish  or  retard 
the  action  of  poisons.  This  is  true  of  arsenic  and  the  irri- 
tants generally.  The  narcotism  produced  by  opium  seems 
to  produce  a  similar  effect,  and  also  to  mask  the  symptoms. 

A  knowledge  of  the  Evidences  of  poisoning  constitutes 
an  important  point  to  the  toxicologist.  These  evidences 
comprise  (i)  those  derived  from  the  Symptoms ;  (2)  those 
obtained  from  the  Post-mortem  appearances ;  (3)  those 
afforded  by  Chemical  analysis;  (4)  those  derived  from 
Experiments  on  animals ;  (5)  the  Moral  or  Circumstantial 
evide7ices. 


39  6  TOXICOLOGY. 

I.  Evidences  afforded  by  Symptoms. — These  consti- 
tute a  very  important  factor  in  the  diagnosis  of  poisoning, 
but,  alone,  they  can  never  be  sufficient  to  establish  the  fact, 
although  they  often  furnish  a  very  strong  presumption. 
There  are  no  characteristic  symptoms  of  any  poison  ;  if 
this  were  the  case  there  would  be  no  need  of  ever  making 
a  chemical  examination,  since  the  symptoms  alone  would 
be  sufficient  to  decide  the  case.  To  this  there  may  be 
an  exception  in  poisoning  by  the  strong  mineral  acids  and 
alkalies,  the  local  action  of  which  is  so  apparent. 

The  first  point  to  notice  is  the  sudden  occurrence  of 
violent  symptoms  in  a  perfectly  healthy  person,  soon  after 
taking  food  or  drink.  Moist  poisons  produce  their  effects 
very  soon  after  their  administration  —  some  of  them  almost 
immediately.  But  if  given  in  very  small  quantities,  and  at 
intervals,  as  in  slow  poisoning,  the  symptoms  may  come  on 
gradually,  and  be  readily  mistaken  for  disease.  The  physi- 
cian should  be  extremely  cautious  about  mentioning  suspi- 
cions of  poisoning  in  a  case  of  this  character  before  he  has 
thoroughly  investigated  the  case. 

The  suspicion  is  strengthened  if  several  persons,  after 
partaking  of  the  same  food,  are  suddenly  seized  with  the 
same  severe  symptoms.  But  even  here  it  might  happen 
that  some  disease,  like  cholera,  may  have  simultaneously 
attacked  several  persons  after  partaking  of  a  meal.  Taylor 
mentions  an  instance  of  this  character,  occurring  in  London, 
where  three  out  of  four  members  of  a  family,  under  suspi- 
cious circumstances,  were  suddenly  seized  with  violent  symp- 
toms that  were  strongly  indicative  of  irritant  poisoning,  but 
which  proved  to  be  malignant  cholera,  which  was  prevailing 
at  that  time. 

A  third  feature  connected  with  the  symptoms  is  their 


EVIDENCES    AFFORDED    BY    POISONING.  39/ 

rapid  course  toward  a  fatal  termination.  This,  however,  is 
not  of  much  practical  value,  since  the  most  active  poisons 
do  not  always  prove  fatal  immediately,  while,  on  the  other 
hand,  many  diseases  run  their  course  very  rapidly. 

From  what  has  just  been  said  about  symptoms  it  will  be 
readily  understood  that  the  practical  difficulty  consists  in 
distinguishing  between  these  and  the  symptoms  of  disease. 
We  shall,  therefore,  briefly  consider  those  diseases  whose 
symptoms  most  resemble  the  symptoms  accompanying 
poisoning.  The  disorders  which  most  simulate  irritant 
poisons  are  cholera  morbus,  malignant  cholera,  gastro- 
enteritis, peritonitis,  ulceration  of  the  stomach,  ileus,  and 
hernia.  Those  which  most  resemble  narcotic  poisoning 
are  apoplexy,  epilepsy,  inflammation  of  the  brain,  tetanus 
and  certain  cardiac  diseases. 

Cholera  morbus  strongly  resembles  arsenic  poisoning,  and 
is  frequently  mistaken  for  it.  Two  cases  of  this  character 
were  reported,  in  which  death  occurred  in  about  eight 
hours,  both  of  which  were  mistaken  for  cholera  morbus 
by  the  attending  physician,  and  were  so  certified  before  the 
Board  of  Health  ;  but  both  of  which,  however,  yielded,  by 
analysis,  the  most  positive  evidence  of  arsenical  poisoning. 

Malignant  cholera  most  resembles  the  action  of  tartar 
emetic  in  its  symptoms,  such  as  the  excessive  nausea  and 
vomiting,  the  rice-water  dejections,  the  cramps,  the  ex- 
treme weakness,  etc.  Gastro-entcritis,  peritonitis,  ulcera- 
tion of  the  stomach,  ileus  and  he^^riia  all  present  symptoms 
which  strongly  resemble  many  of  those  witnessed  from 
irritant  poisons. 

Many  of  the  features  of  apoplexy  bear  a  striking  resem- 
blance to  the  symptoms  of  opium  poisoning  ;  whilst  epilepsy 
in  some  of  its  symptoms  resembles  poisoning  from  hydro- 


398  TOXICOLOGY. 

gen  cyanid  ;  and  the  effects  of  strychnin  bear  a  strong  like- 
ness to  these  of  tetanus. 

A  knowledge  of  the  above  facts  should  put  the  practi- 
tioner upon  his  guard  against  too  hastily  deciding  on  a  case 
of  poisoning  from  the  symptoms  alone  ;  and,  on  the  other 
hand,  he  should  not  be  misled  in  attributing  to  a  supposed 
disease  what  is  really  the  result  of  a  poison. 

II.  Evidences  obtained  from  Post-mortem  Examina- 
tion. —  The  rules  governing  an  autopsy  in  a  case  of  poison- 
ing are  the  same  as  those  which  regulate  other  post-mortem 
examinations.  One  important  rule  should  always  be  ob- 
served, namely,  that  the  examination  should  be  thorough 
and  exhaustive,  so  as  to  overlook  no  lesion  and  no  cause 
of  either  accidental  or  natural  death.  The  rules  already 
given  for  conducting  a  post-mortem  investigation  need  not 
be  repeated  here. 

The  importance  of  receiving  the  stomach  and  other 
viscera  into  a  perfectly  clean  jar  may  be  inferred  from  the 
fact  that  the  showing  that  this  vessel  was  not  clean,  at  the 
trial,  would  be  sufficient  to  destroy  all  the  chemical  testi- 
mony. This  is  well  illustrated  by  a  case  in  the  experience 
of  Robert  Bridges.  The  viscera  had  been  carelessly  placed 
in  a  tin  can  that  had  contained  zinc  paint.  The  analyst 
discovered  zinc  in  the  viscera,  for  which  he  was  at  a  loss  to 
account  until  the  above  fact  was  ascertained. 

In  the  examination  of  the  stomach  it  is  recommended  to 
open  this  organ  along  the  lesser  curvature,  and,  after  care- 
fully collecting  and  measuring  the  contents,  to  spread  it 
out  upon  a  clean  pane  of  glass  or  large  flat  dish,  with  the 
mucous  surface  outward ;  it  should  then  be  carefully  in- 
spected,  with  the  aid   of  a  magnifier,  and  any  abnormal 


EVIDENCES    FROM    POST-MORTfiM    EXAMINATION.         399 

.  appearance  noted,  together  with  any  foreign  substance,  such 
as  crystals  of  arsenic,  fragments  of  phosphorus,  suspicious 
powders,  pieces  of  vegetable  matter,  etc.  These  should 
afterward  be  examined  with  the  microscope. 

The  evidences  furnished  by  the  post-mortem,  like  those 
derived  frorii  the  symptoms,  can  never  be  absolutely  con- 
clusive, but  only  strongly  suggestive  ;  for  many  diseases 
exhibit  precisely  the  same  post-mortem  lesions.  Some- 
times the  external  inspection  of  the  body  may  throw  some 
light  on  the  case,  as  when  certain  stains  of  the  mineral 
acids  are  discovered  about  the  mouth,  cheeks,  tongue,  and 
fauces,  and  also  on  the  dress  of  the  person.  Occasionally 
the  odor  of  hydrogen  cyanid,  opium,  alcohol,  nicotin,  or 
phosphorus  may  be  perceived  on  the  corpse.  On  opening 
the  body,  the  odor  of  such  substances,  if  present,  is  usually 
more  decided ;  and  in  phosphorus-poisoning  the  white 
fumes,  which  are  luminous  in  the  dark,*  as  well  as  the 
garlic-like  odor,  are  often  very  perceptible.  Again,  the 
remnants  of  certain  poisons  may  be  at  times  discovered  in 
the  stomach  and  bowels,  such  as  cantharides,  Scheele's 
green,  nux  vomica,  arsenous  oxid,  and  orpiment ;  also 
vegetable  leaves  and  fibers,  which  latter  may  be  recognized 
by  their  structure.  The  aid  of  the  microscope  may  here 
be  required. 

As  regards  the  true  pathological  lesions  resulting  from 
poisoning,  it  may  be  remarked  that,  as  a  rule,  the  irritant 
poisons  leave  behind  them  decided  marks  of  congestion  and 
inflammation  of  the  mucous  membrane  of  the  stomach  and 
bowels,  together,  at  times,  with  ulceration,  perforation,  and 
gangrene  ;  while  the  neurotics  leave  their  impress  upon  the 
brain  and  spinal  cord,  in  the  form  of  congestion,  inflamma- 
tion and  effusion  in  these  organs,  and  sometimes  congestion 


400  TOXICOLOGY, 

of  the  lungs.  The  negative  evidence,  in  the  absence  of  all 
marks  of  irritation  of  the  stomach  and  bowels,  against  irri- 
tant poisoning,  although  strong,  is  not  absolute,  because,  in 
exceptional  cases,  death  from  these  powerful  irritants  may- 
occur  without  leaving  behind  any  pathological  lesion. 

Among  the  most  common  of  the  post-mortem  signs  pro- 
duced by  irritant  poisons  is  redness ;  this,  however,  is  a 
constant  symptom  attendant  on  many  disorders  ;  and  it 
occurs  simply  as  a  post-mortem  change.  A  similar  conges- 
tion is  also  witnessed  in  some  cases  of  death  by  suffocation, 
strangling,  hanging,  and  drowning.  The  examiner  should 
hence  beware  of  attaching  too  much  importance  to  this  sign 
exclusively.  Ulceration  is  occasionally  the  result  of  irri- 
tant poisoning.  It  is,  however,  much  more  frequently  the 
sequence  of  disease ;  and,  as  this  latter  is  apt  to  be  insidi- 
ous and  generally  unsuspected  until  a  sudden  fatal  termina- 
tion, it  might  readily  be  mistaken  for  a  case  of  poisoning. 
Softening  of  the  mucous  lining  of  the  stomach  and  bowels 
may  result  from  both  poisoning  and  disease;  it  cannot, 
therefore,  be  accepted  as  a  proof  of  the  former.  Perfora- 
tion may  occur  from  the  action  of  a  corrosive,  as  the  min- 
eral acids  and  alkalies,  and  also  from  disease ;  but  in  the 
latter  case  the  aperture  is  small,  while  in  the  former  it  is 
large  and  ragged,  and  its  edges  are  soft  and  friable  ;  more- 
over, the  poison  escapes  into  the  abdomen,  and  can  there 
readily  be  detected. 

All  substances  taken  in  doses  sufficient  to  cause  severe 
symptoms  probably  produce  structural  and  chemical  changes 
in  the  visceral  tissues,  but  as  yet  the  data  are  very  incom- 
plete. Some  well-established  conditions  will  be  noted  in 
connection  with  particular  poisons.  The  following  table  of 
effects  of  different  poisons  on  the  condition  of  the  blood  is 
taken  from  DaCosta's  "Clinical  Hematology": 


EVIDENCE    FROM    CHEMICAL    ANALYSIS. 


401 


Substance. 

Alcohol, 

Amyl  nitrite, 

Acetanilid, 

Ammonium  hydroxid, 

Antipyrin, 

Bromin, 

Chloral, 

Chromic  acid, 

Ether, 

Guaiacol, 

Hydrogen  cyanid, 

Illuminating  gas, 

lodin, 

Lead, 

Nitrobenzene, 

Nitroglycerin, 

Phenacetin, 

Phosphorus, 

Potassium  chlorate, 

Sodium  nitrite. 
Poisonous  mushrooms, 


Effects. 
Anemia,  often  leukocytosis. 
Methemoglobinemia. 
Methemoglobinemia. 
Leukocytosis. 
Methemoglobinemia. 
Methemoglobinemia. 
Leukocytosis. 
Methemoglobinemia. 
Oligochromemia. 
Hemocytolysis,  leukocytosis. 
Methemoglobinemia. 
Methemoglobinemia,  polycythe- 
mia. 
Leukocytosis,    methemoglobine- 
mia. 
Anemia,     granular     basophilia, 

often  leukocytosis. 
Methemoglobinemia,       megalo- 
blastic anemia. 
Methemoglobinemia. 
Methemoglobinemia. 
Polycythemia,  occasionally  leu- 
kocytosis. 
Methemoglobinemia,       anemia, 

leukocytosis. 
Methemoglobinemia. 
Hemoglobinemia. 


III.  Evidences  from  Chemical  Analysis. — The  actual 
discovery  of  the  poison  by  means  of  chemical  analysis  is 
usually  regarded  as  the  most  satisfactory  and  positive  evi- 
dence of  poisoning;  and  it  is  a  prevalent  notion  that  the 
case  cannot  be  made  out,  without  the  production  of  the 

34 


402  TOXICOLOGY. 

poison,  as  the  corpiis  delicti.  This  is,  however,  an  error. 
The  law  requires  the  satisfactory  proof  of  death  by  poison- 
ing. The  question  is,  Can  satisfactory  proof  be  afforded 
without  the  chemical  detection  of  the  poison  ?  The  reply 
to  this  inquiry  is  that  it  undoubtedly  can,  in  certain  cases. 
Many  convictions  have  occurred  in  trials  for  poisoning, 
without  this  particular  line  of  proof.  If  it  were  always 
deemed  absolutely  essential,  doubtless  many  criminals 
would  escape.  It  is  well  understood  that  for  certain 
poisons  there  is  no  known  characteristic  test ;  besides,  cir- 
cumstances may  interfere  to  prevent  a  proper  examination. 
If,  however,  the  other  branches  of  evidence  fail,  and  if,  at 
the  same  time,  the  analytic  proofs  are  unsatisfactory,  then 
the  case  must  be  abandoned. 

On  the  other  hand,  supposing  the  analysis  reveals  the 
presence  of  poison  in  the  stomach,  this  does  not  necessarily 
prove  that  the  death  resulted  from  poisoning.  Indeed,  in  the 
absence  of  the  usual  symptoms,  the  pathological  lesions, 
and  other  proofs,  it  might  plausibly  justify  the  suspicion 
that  the  poison  had  been  secretly  introduced  into  the  body 
after  death,  for  sinister  purposes,  or  without  evil  intention, 
as  in  the  case  of  so-called  embalming  with  certain  poisonous 
mineral  substances. 

The  detection  of  the  absorbed  poison  in  the  organs,  as 
the  liver,  spleen,  kidney,  etc.,  is  justly  regarded  as  a  more 
satisfactory  proof  of  poisoning  than  the  mere  discovery  of  it 
in  the  stomach.  It  should  not  be  forgotten  that  if  a  poison 
in  a  Hquid  state  be  introduced  into  the  stomach  or  rectum 
of  a  dead  body,  by  means  of  a  tube,  in  a  short  time  the 
liquid  will  diffuse  through  the  walls  of  the  viscus,  will  come 
in  contact  with  the  adjacent  organs  —  the  liver,  lungs,  pan- 
creas, kidney,  spleen,  etc. — and  will  penetrate  so  as  to  con- 


EVIDENCE    FROM    CHEMICAL    ANALYSIS.  403 

taminate  them  more  or  less.  The  same  result  would  occur 
if  the  body  had  been  embalmed  by  the  injection  into  the 
blood-vessels  of  some  poisonous  material,  such  as  arsenic 
or  corrosive  sublimate.  Now  if,  after  several  weeks'  or 
months'  interment,  a  suspicion  be  aroused  that  the  death 
had  been  caused  by  poison,  and  the  body  then  be  opened, 
very  decided  evidences  will  be  afforded  by  the  different 
organs  of  what  might  very  naturally  be  mistaken  for  ab- 
sorbed poison. 

The  author  is  familiar  with  a  case  of  post-mortem  imbi- 
bition, the  particulars  of  which  were  communicated  to  him  ; 
and  in  order  to  establish  the  possibility  of  its  occurrence, 
together  with  the  circumstances  most  favorable  for  its  pro- 
duction, he  had  a  series  of  experiments  made,  under  his 
supervision,  by  Dr.  Geo.  McCracken,  of  the  University  of 
Pennsylvania,  on  the  bodies  of  dogs  and  cats,  with  solutions 
of  arsenous  oxid,  corrosive  sublimate,  and  tartar  emetic, 
confining  his  experiments,  for  the  time,  to  mineral  poisons. 
These  solutions  were  severally  injected  into  the  stomachs 
of  the  animals,  and  their  bodies  were  buried  for  periods, 
respectively,  of  three,  five,  six,  and  seven  weeks,  when 
they  were  disinterred,  opened,  and  the  different  viscera 
subjected  to  careful  analysis,  with  the  following  results  : 
After  three  weeks'  burial,  in  the  case  of  all  the  poisonous 
solutions,  the  characteristic  colored  spots  of  the  respective 
sulphids  were  seen  on  the  spleen,  under  surface  of  the 
liver,  and  that  portion  of  the  peritoneum  posterior  to  the 
stomach  :  yellow  in  the  case  of  arsenic,  red  in  the  case 
of  antimony,  and  black  in  the  case  of  mercury.  Each  of 
the  metals  was  likewise  discovered  by  analysis  in  the  liver, 
spleen,  and  left  kidney,  the  greatest  amount  being  found  in 
the  spleen  ;    next,  in  the  portion  of  the  liver  joining  the 


404  TOXICOLOGY. 

stomach  ;  then  in  the  left  kidney  ;  and  next  in  the  portion 
of  liver  farthest  from  the  stomach,  and  none  in  the  right 
kidney.  After  six  and  seven  weeks'  interment,  the  colored 
sulphid  deposits  were  much  more  decided,  being  noticed  on 
the  upper,  as  well  as  the  lower,  surface  of  the  liver,  to- 
gether with  the  spleen,  intestines,  omentum,  and  both  kid- 
neys, and,  in  the  case  of  arsenic,  even  extending  as  low 
as  the  fundus  of  the  bladder.  The  poisons  were  detected 
in  all  the  above-mentioned  organs. 

The  inference  from  the  above  facts  would  naturally  lead 
to  the  necessity  of  considering  the  question  of  the  post- 
mortem introduction  of  the  poison,  in  every  toxicologic 
investigation.  It  is  evident  that  it  would  often  not  be  a  very 
difficult  matter  secretly  to  introduce  a  poisonous  liquid  into 
the  stomach  of  a  dead  person,  and,  after  the  lapse  of  a  few 
weeks  or  months,  to  circulate  the  rumor  of  the  death  having 
been  produced  by  poison.  This  would  probably  lead  to 
the  disinterment  of  the  body,  and  the  analytic  examination 
would  reveal  the  existence  of  the  poison,  not  only  in  the 
stomach,  but  also  in  the  liver  and  other  viscera.  The  con- 
clusion then  would  naturally  be  that  the  individual  had 
died  from  poison,  because  it  had  been  discovered  in  the 
organs.  The  case  may  occur  (as  has  actually  occurred)  in 
which  there  was  a  strong  suspicion  of  death  from  arsenical 
poison,  but  in  which  the  body  was  embalmed  immediately 
after  death  by  the  injection  of  an  arsenic  solution  into  the 
abdomen,  with  the  intention,  doubtless,  of  confusing  the 
results  of  analysis. 

Now,  the  all-important  question  here  is  :  Is  it  possible  to 
discriminate,  by  a  post-mortem  examination  of  the  liver  and 
other  organs  of  the  body,  between  a  genuine  case  of  poison- 
ing and  one  in  which  these  same  organs  had  become  affected 


POST-MORTEM    IMBIBITION    OF    POISONS.  405 

by  post-mortem  imbibition  ?  Certainly  not  by  merely  ana- 
lytic tests,  since  these  would  afford  similar  results  in  both 
cases.  Until  quite  recently  it  seemed  that  a  poison  injected 
into  the  stomach  or  bowels  of  a  dead  body,  or  in  the  pro- 
cess of  embalming,  could  not  penetrate  through  the  bony 
cavities  of  the  cranium  and  spinal  canal,  by  osmosis,  as  we 
know  to  be  the  case  with  the  different  organs  of  the  abdo- 
men and  chest.  Nevertheless,  certain  experiments  in  this 
line,  performed  by  Dr.  G.  B.  Miller  and  Mr.  F.  S.  Sutton, 
of  Philadelphia,  do  seem  to  prove  that  a  solution  of  arsen- 
ous  oxid  (and,  inferentially,  other  poisons),  injected  into  the 
stomach  of  a  dead  animal,  can,  after  a  sufficient  lapse  of 
time,  be  discovered  in  the  brain  and  spinal  marrow,  and 
even  in  the  bones  of  the  cranium,  by  the  usual  analytic 
reagents.  But  how  this  diffusion  can  be  accomplished  through 
the  bony  walls  of  these  cavities  is  difficult  to  understand. 

The  results  of  some  later  experiments  of  Dr.  Miller  in- 
dicate that  strychnin  (and  presumably  the  other  alkaloids), 
when  injected  into  the  stomach  of  a  dead  rabbit,  will  pene- 
trate by  imbibition  into  the  liver,  spinal  cord,  and  bladder ; 
the  poison  having  been  detected  in  these  localities,  though 
not  in  the  brain. 

Experiments  made  by  Vaughan  and  Dawson,  and  also 
by  Witthaus,  on  human  cadaver,  have  shown  that  compara- 
tively rapid  diffusion  of  poison  may  occur  when  it  is  intro- 
duced after  death.  In  one  experiment  (Witthaus)  the 
brain  contained  .00828  gram  of  arsenous  oxid  five  days 
after  the  injection  of  16.56  grams  in  solution  into  the 
stomach.  Even  the  long-continued  external  application 
of  cloths  containing  arsenical  solutions  has  resulted  in  ab- 
sorption into  the  abdominal  viscera,  as  in  a  case  reported 
by  Mason. 


406  TOXICOLOGY. 

Dr.  Charles  Harrington  has  kindly  furnished  the  follow- 
ing details  of  an  interesting  case  of  post-mortem  imbibition. 
A  man  died  of  what  was  certified  to  be  influenza.  There  was 
no  reason  to  suppose  foul  play,  but  some  of  the  relatives, 
dissatisfied  with  the  terms  of  the  will  of  the  deceased,  al- 
leged poisoning,  and  the  authorities  were  obhged  to  make 
an  examination.  The  body  had  been  embalmed  with  a 
solution  containing  much  arsenic  and  then  placed  in  a  re- 
ceiving vault  because  the  weather  was  too  cold  to  permit 
the  digging  of  the  grave.  When  the  body  was  prepared 
for  examination  it  was  found  to  be  frozen  ;  the  post-mortem 
was  proceeded  with  as  soon  as  it  was  sufficiently  thawed. 

The  stomach,  intestines,  liver,  kidneys  and  spleen  ap- 
peared to  be  absolutely  normal.  There  was  no  sign  of 
irritation  or  fatty  degeneration.  The  spinal  canal  was 
opened  and  the  cord  removed,  taking  great  pains  not  to 
allow  it  to  come  in  contact  with  any  of  the  other  parts,  and 
also  not  to  transfer  of  the  embalming  fluid  to  it  with  instru- 
ment or  fingers.  Analysis  of  the  cord  gave  very  strong 
evidence  of  the  presence  of  arsenic. 

These  observations "  tend  to  deprive  us  of  important 
means  of  discrimination.  Probably,  the  next  best  criterion 
in  such  an  uncertainty  is  the  fact  alluded  to  by  Orfila  that, 
in  a  case  of  true  post-mortem  imbibition,  the  poison  would 
be  found  on  the  exterior  rather  than  on  the  interior  of  the 
organs  ;  while  in  a  case  of  poisoning,  the  absorbed  poison 
would  probably  be  deposited  uniformly  in  the  interior  of  the 
organs. 

Again,  the  discovery  of  the  poison  in  the  solid  state  in  the 
stomach  might  be  regarded  as  strong  evidence  of  ante- 
mortem  administration  ;  but  the  finding  of  a  liquid  poison 
in  that  organ,  although  strongly  suggestive,  is  not  positive 


FAILURE    OF    CHEMICAL    ANALYSIS.  407 

proof  of  the  same,  since,  as  we  have  seen,  it  is  possible  to 
inject  such  a  liquid  into  this  cavity  after  death. 

Still  another  aid  in  this  investigation  is  afforded  by  test- 
ing the  urine.  The  discovery  of  the  suspected  poison  in 
this  secretion  might  be  regarded  as  conclusive  evidence  of 
ante-mortem  administration.  But  even  this  is  open  to  the 
possible  objection  that  the  bladder,  in  common  with  the 
other  abdominal  viscera,  might  be  contaminated  by  imbibi- 
tion of  the  injected  poison,  which  might  thus  possibly  affect 
the  contained  urine.  Probably  the  most  satisfactory  and 
scientific  diagnostic  mark  would  be  the  microscopic  proof 
of  a  histological  and  pathological  change  wrought  in  the 
tissue  or  organ  impregnated  with  the  poison.  This  could 
only  occur  by  absorption  of  the  poison  during  life  ;  such 
changes  are  not  induced  by  poisons  introduced  into  the 
dead  body.  It  is  very  certain  that  this  important  subject 
requires  further  attention  on  the  part  of  experts. 

Analysis  sometimes  fails  entirely  to  discover  the  poison 
after  death,  and  for  this  failure  several  good  reasons  can  be 
assigned  :  ( i )  It  may  all  have  disappeared  before  death  by 
vomiting  and  purging,  and  by  elimination  through  the 
secretions.  Arsenous  oxid,  however,  is  very  apt  to  adhere 
to  the  mucous  lining  of  the  stomach,  in  spite  of  long  and 
violent  vomiting.  (2)  It  may  be  undiscoverable  by  tests  at 
present  available.  (3)  Loss  by  absorption  and  elimination 
may  occur.  This  is  apt  to  be  the  case  when  the  dose  of 
the  poison  was  only  just  sufficient  to  cause  death,  and 
death  not  very  rapid.  (4)  The  decomposition  of  the  poison 
in  the  blood  or  during  its  elimination.  This  is  much  more 
apt  to  occur  with  organic  than  with  inorganic  substances. 
(5)  Its  possible  decomposition  in  the  dead  body.  This 
does  not  occur  with  the  mineral   poisons ;     although   the 


408  TOXICOLOGY, 

chemical  composition  of  these  may  undergo  change  after 
death,  as  e.  g.,  arsenous  oxid  into  the  yellow  sulphid,  yet 
the  element  remains.  (6)  The  presence  of  one  or  more 
ptomaines  may  seriously  complicate  the  detection  of  some 
poisons. 

In  performing  a  toxicologic  analysis,  certain  rules  should 
be  observed.  The  examiner  should,  if  possible,  inform 
himself  of  the  character  of  the  symptoms,  and,  if  the 
case  was  fatal,  of  the  post-mortem  appearances,  as  these 
will  usually  indicate  to  what  particular  class  of  poi- 
sons he  should  direct  his  researches.  In  searching  for 
the  more  complex  organic  poisons,  it  is  a  good  plan  to 
reduce  the  liquid,  by  evaporation  at  a  gentle  heat,  to  a  very 
small  bulk,  since  a  minute  quantity  of  a  poison  diffused 
through  a  large  amount  of  water  may  fail  to  respond  to 
the  proper  tests.  It  is  best,  also,  to  operate  on  one  half  of 
the  material,  reserving  the  other  portion  in  case  of  acci- 
dent or  for  further  experiments.  The  suspected  substance 
ought  to  respond  to  all  the  recognized  tests,  the  character- 
istic ones  being  first  applied  ;  and  in  metallic  poisoning  it 
is  often  required  to  produce  the  element  as  evidence.  This 
can  always  be  accomplished  without  much  difficulty  in  the 
case  of  arsenic,  mercury,  antimony,  copper,  lead ;  but  it 
should  also  be  remembered  that  the  results  are  modified 
by  the  quantity  of  the  reagent  employed.  Reliance  should 
not  be  placed  on  the  mere  color  of  precipitates,  as  this  is 
often  fallacious,  from  being  disguised  by  admixture  with 
foreign  matters,  or  uncertain,  from  its  resemblance  to  other 
substances.  As  instances  may  be  cited  the  impure  arsenic 
and  antimony  sulphids,  the  precipitates  in  the  liquid  tests 
for  arsenic,  and  the  resemblance  between  the  action  of  ferric 
salts  upon  the  saliva  and  upon  hydrogen  cyanid.      Finally, 


EVIDENCES    FROM    EXPERIMENTS.  4O9 

the  analyst  should  be  careful  to  test  the  purity  of  all  his 
reagents,  remembering  that  many  of  the  so-called  pure 
reagents  often  contain  impurities,  which  may  seriously 
damage  his  examination.  As  an  example  of  the  liability 
of  reagents  to  contain  impurities,  the  case  recently  reported 
by  Vaughan  may  be  cited.  Fifty  cubic  centimeters  of  a 
sample  of  ether,  sold  as  pure  and  intended  for  use  in 
analytic  work,  was  found  to  contain  an  organic  body  of  such 
poisonous  character  that  it  killed  a  guinea-pig  in  ten  minutes. 

IV.  Evidences  from  Experiments  on  Living  Ani- 
mals.— When  the  poison  cannot  be  identified  by  the  symp- 
toms, post-mortem  lesions,  and  chemic  tests,  the  suspected 
material  may  be  introduced  into  a  living  animal,  and  its 
effects  noted.  In  the  case  of  strychnin,  the  frog  would  be 
appropriate  as  a  corroborative  test.  Birds  are  not  so  well 
adapted  for  experiment.  The  character  of  the  informa- 
tion thus  derived  is  confined  to  the  mere  fact  of  poison- 
ing, together  with  some  of  its  physiologic  and  pathologic 
actions.  By  this  means  the  presence  of  digitalin  was 
identified  in  a  celebrated  French  case,  and  aconitin  in  the 
case  of  Dr.  Lamson,  in  England. 

The  material  to  be  employed  in  such  cases  is  usually  the 
matters  vomited,  or  that  found  in  the  stomach  and  bowels 
of  the  deceased  ;  but  the  examiner  should  avoid  a  too  hasty 
conclusion,  inasmuch  as  disease  might  cause  the  secretions 
of  the  alimentary  canal  to  become  infected,  and  thus  to  act 
upon  the  animal  poisonously,  although  no  poison  had  really 
been  taken  by  the  deceased  ;  and  on  the  other  hand,  although 
poison  may  originally  have  been  present  in  the  stomach,  it 
might  have  all  been  expelled  by  vomiting,  or  undergone 
decomposition,  so  that  the  contents  of  the  stomach  would 


4IO  ^  TOXICOLOGY. 

no  longer  produce  a  poisonous  impression  on  the  animal. 
When  the  quantity  of  the  material  is  small,  as  in  the  case 
of  an  ultimate  vegetable  extract,  it  is  advisable  to  introduce 
it  into  a  very  small  animal,  as  the  mouse,  hypodermically. 
Another  fact  to  be  noticed  in  this  connection  is  that  a 
poison  may  be  introduced  into  the  human  system  through 
the  body  of  an  animal,  without  the  latter  being  affected  by 
it.  A  case  is  recorded  where  a  family  exhibited  all  the 
evidences  of  belladonna-poisoning  after  partaking  of  a  rab- 
bit pie  ;  the  defense,  which  was  successfully  set  up,  was 
that  the  animal  had  previously  eaten  of  the  belladonna 
plant,  by  which  its  flesh  had  become  poisonous.  It  is  well 
known  that  the  cow  and  goat  will  feed  upon  stramonium 
with  impunity,  and  that  their  milk  will  act  poisonously  upon 
those  who  partake  of  it. 

V.  Evidences  Derived  from  Circumstances. — The  med- 
ical expert  is  not  directly  concerned  with  this  sort  of  testi- 
mony, and  it  is  best  for  this  feature  of  the  question  to  be 
left  to  the  legal  authorities.  In  poison  cases,  however,  the 
medical  and  other  evidence  is  so  closely  connected  that  the 
expert  may  be  consulted  in  regard  to  the  latter.  These 
"  circumstances  "  are  the  following  :  (i)  Any  suspicious  con- 
duct of  the  accused  before  the  event.  (2)  Proof  of  the  pur- 
chase and  possession  of  poison  by  the  accused.  Of  course, 
this  may  be  satisfactorily  accounted  for ;  though  often  re- 
markable reasons  are  assigned  by  the  accused,  as  in  a  New 
Jersey  case,  where  a  woman  was  tried  and  convicted  for 
attempting  to  poison  her  son  with  successive  small  doses  of 
croton  oil ;  the  alleged  reason  for  its  purchase  and  posses- 
sion being  that  it  was  for  the  cure  of  her  corns.  (3)  The 
proof  of  administration  in  the  food  or  drink  of  the  deceased. 


EVIDENCES  FROM  CIRCUMSTANCES.         4II 

(4)  A  sufficiently  strong  motive  for  the  act.  (5)  Suspicions 
conduct  of  the  accused  during  the  illness  and  after  the  death 
of  the  deceased — such  as  preventing  his  obtaining  medical 
advice ;  assuming  the  exclusive  care  of  the  person,  as  to 
the  giving  of  his  food  or  administering  the  medicines  ;  care- 
fully removing  and  disposing  of  all  vomited  matters,  to- 
gether with  the  excreta ;  and  expressing  the  opinion  of  the 
probability  of  a  speedy  and  fatal  termination  of  the  case  ; 
and,  after  the  death,  opposing  an  autopsy,  hastening  the 
burial,  and  giving  a  false  account  of  the  illness. 

Certain  questions  will  naturally  present  themselves  in 
every  case  of  poisoning  that  comes  up  for  trial  :  (i)  Is  the 
death  or  sickness  to  be  ascribed  to  poison  ?  This  question  is 
fundamental,  as  it  compels  the  expert  to  exhibit  his  proofs 
of  the  poisoning.  (2)  What  is  the  nature  of  the  alleged 
poisoning?  It  is  rarely  in  the  power  of  the  toxicologist  to 
exhibit  the  identical  poison  that  caused  the  death,  as  the 
corpus  delicti.  In  most  cases,  all  that  is  possible  to  do  is  to 
demonstrate  all  the  known  chemic  and  (occasionally)  phy- 
siologic tests.  In  the  case  of  the  mineral  poisons,  it  is 
deemed  sufficient  to  exhibit  the  element  and  the  results  of 
the  recognized  chemical  reactions.  In  some  cases  of  min- 
eral poisons,  however,  it  is  possible  to  extract  the  identical 
substance  that  was  administered  —  such  as  arsenous  oxid, 
corrosive  sublimate,  tartar  emetic,  etc. — by  the  process  of 
dialysis.  (3)  Was  the  substance  administered  capable  of 
causing  death  ?  If  it  can  be  shown  that  the  substance, 
although  criminally  administered,  was  not  poisonous,  al- 
though supposed  to  be,  it  would  not  be  possible  to  establish 
a  case  of  poisoning  ;  neither,  if  the  substance  were  poison- 
ous only  in  large  doses,  as  oxalic  acid,  and  a  very  small 
quantity,  only  a  few  grains,  had  been  given.     (4)    Was  the 


4 1  2  TOXICOLOGY. 

poison  taken  in  sufficient  quantity  to  produce  death  ?  The 
discovery  of  a  large  amount  of  poison  in  the  body  is  a 
pretty  sure  evidence  of  the  cause  of  death  ;  but  the  finding 
of  only  a  minute  quantity,  or  its  total  absence  from  the 
body,  is  not  positive  proof  that  death  was  not  caused  by 
poison.  (5)  When  zvas  the  poison  taken?  This  question 
can  generally  be  answered  by  referring  to  the  time  of  the 
first  appearance  of  the  symptoms,  together  with  their  dura- 
tion ;  but  it  is  affected  by  various  conditions.  (6)  May  the 
poison  have  entirely  disappeared  from  the  body  zvithoiit  leav- 
ing any  trace  ?  The  answer  must  be  affirmative  if  the  per- 
son has  survived  long  enough  to  allow  of  its  complete 
elimination.  (7)  Might  the  poison  found  in  the  body  he  as- 
cribed to  any  other  source  than  to  poisoning  ?  Not  as  a 
general  rule,  if  it  is  found  in  considerable  quantities,  and  in 
the  absorbed  state  in  the  organs,  although  the  possibility  of 
post-mortem  imbibition  should  not  be  forgotten.  But  if  in 
minute  quantity,  it  might  have  been  introduced  medicinally 
or  accidentally.  (8)  Can  poisoning  be  pretended?  Undoubt- 
edly, just  as  various  diseases  are  feigned  for  some  special 
motive.  The  idea  of  being  poisoned  is  a  very  common 
delusion  of  the  insane. 

This  summary  is  chiefly  from  Tardieu. 

Classification  of  Poisons.  —  Of  the  numerous  classifi- 
cations of  poisons  which  have  been  proposed  at  various 
times,  one  only  requires  notice  here.  This,  which  may  be 
termed  the  physiologic,  has  reference  to  the  effects  of  poi- 
sons upon  the  healthy  system,  and,  as  adopted  in  the  pres- 
ent treatise,  is  founded  upon  the  latter  arrangement  as 
being  the  most  philosophic.  It  is  based  upon  the  one 
proposed  by  Taylor,  with  a  few  modifications  which  render 
it  simple  and  convenient. 


CLASSIFICATION    OF    POISONS.  4I3 

Poisons  are  divisible  into  two  Classes:  I.  Irritants;  II. 
Neurotics. 

I.  Irritants. — These  include  such  poisons  as  produce  an 
irritant  action  upon  the  mucous  lining  of  the  alimentary- 
canal,  the  effects  being  nausea,  vomiting,  purging,  pain  in 
the  abdomen,  cramps  in  the  stomach  and  other  parts  of  the 
body ;  the  matters  vomited  and  purged  being  at  times 
mixed  with  blood.  The  post-mortem  lesions  are  more 
or  less  inflammation  of  the  gastro-intestinal  mucous  mem- 
brane ;  sometimes  ulceration,  perforation,  and  gangrene. 

The  irritants  may  be  divided  into  the  Corrosives  and  Irri- 
tants proper.  The  former  produce  local  destruction  of  tissue, 
the  effects  of  which  often  overshadow  the  true  internal  action. 

II.  Neurotics.  —  These  are  so  named  on  account  of  their 
specific  action  on  the  great  nervous  centers.  The  symp- 
toms are  altogether  distinct  from  those  of  the  former  class, 
being  directed  especially  to  the  brain  and  spinal  cord. 
These  are  drowsiness,  giddiness,  headache,  delirium,  stupor, 
coma,  and  sometimes  convulsions  and  paralysis.  They  are 
naturally  subdivided  into  three  Orders  :  (i)  Cerebral,  (2) 
Spinal,  (3)  Cerebro-spinal.  The  first  of  these  Orders  com- 
prises Narcotics  and  Anesthetics.  The  second  Order  in- 
cludes those  which  act  directly  upon  the  spinal  cord,  such 
as  strychnin  ;  they  are  sometimes  termed  Tetanies.  The 
third  Order  comprises  those  which  influence  both  the  brain 
and  spinal  marrow,  producing  dehrium,  coma,  convulsions, 
and  paralysis.  These  latter  may  be  grouped  under  the 
three  heads  of  Deliriants,  Depressants,  and  Asthenics.  The 
above  arrangement  is  to  a  great  extent  an  arbitrary  one, 
and  must,  of  course,  be  somewhat  imperfect,  as  the  boun- 
dary line  between  the  different  classes  and  orders  of  poisons 
cannot  always  be  accurately  drawn. 


414  TOXICOLOGY. 

CORROSIVE  IRRITANTS. 

MINERAL  ACIDS. 

The  Mineral  Acids  —  Sulphuric,  Nitric,  and  Muriatic  — 
possess  certain  common  characters,  and  produce  certain 
common  effects  upon  the  system,  and  may  properly  be 
considered  together.  This  action  is  largely  local,  although 
death  is  sometimes  due  to  the  shock  upon  the  nerve-centers. 
They  are  seldom  used  for  homicidal  purposes,  except  in 
the  case  of  young  children ;  they  are  occasionally  em- 
ployed by  suicides,  but  more  frequently  cause  death  by 
accident. 

Their  symptoms  are  exhibited  immediately  on  being 
swallowed ;  these  consist  of  a  burning  in  the  mouth  and 
throat,  with  intense  pain  in  the  stomach,  attended  with  con- 
stant vomiting  of  a  brownish  or  blackish  matter,  often 
mixed  with  blood,  together  with  mucus  and  shreds  of 
detached  mucous  membrane.  The  ejected  matters  are  in- 
tensely acid,  and  if  they  happen  to  fall  upon  a  marble  slab 
they  produce  effervescence ;  they  also  change  the  color 
and  destroy  the  texture  of  the  cloth  or  other  material  on 
which  they  may  fall.  Swallowing  is  very  painful,  and 
sometimes  impossible.  Thirst  is  intense  ;  the  bowels  are 
constipated  and  the  urine  diminished.  The  pulse  is  small 
and  weak,  and  the  skin  cold  and  clammy.  Respiration 
becomes  difficult,  and  the  countenance  expressive  of  great 
anxiety.  There  may  also  be  cough  and  difficulty  of  speak- 
ing. Death  may  occur  from  suffocation  when  the  force  of 
the  acid  is  spent  upon  the  glottis  and  upper  portion  of  the 
windpipe.  The  mouth  is  excoriated  and  the  lips  are 
stained  and  shriveled.  When  the  acid  has  been  poured  far 
back  down  the  throat,  in  the  case  of  infants,  the  mouth  and 


MINERAL    ACIDS SYMPTOMS.  4I  5 

lips  may  entirely  escape  injury,  the  corrosive  action  being 
confined  to  the  glottis  and  adjacent  parts.  The  mental 
faculties  usually  remain  clear  until  near  death. 

The  result  is  generally  fatal,  although  the  period  of 
death  may  vaiy  from  a  few  hours  to  weeks  or  months, 
death  often  taking  place  as  a  result  of  injury  done  by  the 
posion  {e.  g.,  stricture  of  esophagus,  destruction  of  mucous 
coat  of  stomach). 

Post-mortem  Appearances.  —  Stains  of  a  brownish  or  yel- 
lowish hue  are  apt  to  be  found  on  the  lips  and  cheeks  ;  also 
on  portions  of  the  dress  of  the  deceased.  The  lining  of  the 
mouth  and  tongue  is  shriveled  and  eroded,  stained  yellowish 
in  the  case  of  nitric  acid,  and  sometimes  of  a  whitish  color. 
At  times  the  mucous  membrane  of  the  windpipe  appears  to 
have  suffered  most  from  the  corrosive  action  of  the  poison, 
and  cases  are  reported  of  sulphuric-acid  poisoning  in  which 
all  other  parts  of  the  body  had  entirely  escaped.  The  lining 
membrane  of  the  esophagus  is  usually  softened,  detached  in 
long  shreds,  and  deeply  congested  ;  the  stomach  contracted, 
often  perforated,  sometimes  blackened,  containing  a  dark 
grumous  liquid ;  at  other  times  it  presents  a  yellowish  ap- 
pearance. The  intestines  are  likely  to  be  inflamed,  unless 
the  death  has  been  very  rapid.  If  the  contents  of  the 
stomach  have  escaped  into  the  cavity  of  the  abdomen, 
through  perforation,  the  peritoneum  will  be  found  intensely 
inflamed,  with  more  or  less  dark,  effused  blood. 

Treatment.  —  No  remedies  are  likely  to  prove  efficient 
when  an  undiluted  acid  has  been  swallowed.  The  proper 
treatment  consists  in  administering  baking  soda,  chalk,  or 
magnesia,  stirred  up  in  water,  barley  water,  flaxseed  tea, 
oil,  etc.  The  stomach  pump  should  not  be  employed,  on 
account  of  the  risk  of  perforating  the  softened  esophagus. 


4l6  TOXICOLOGY. 

Sulphuric  Acid. — This  acid  is  commercially  named  Oil 
of  Vitriol.  In  its  concentrated  state  it  is  a  heavy,  oily  liquid, 
of  a  light  brownish  color;  sp.  gr.,  1.845  \  intensely  sour. 

The  highly  diluted  acid  is  colorless  and  non-corrosive  ; 
paper  which  has  been  dipped  into  it  and  dried  by  a  gentle 
heat  will  be  charred. 

Sulphuric  acid  is  more  frequently  the  cause  of  death  than 
the  other  mineral  acids.  Homicidal  deaths  are  occasionally 
met  with  among  infants,  and  several^  cases  are  reported 
where  it  was  introduced  into  the  rectum  and  vagina.  The 
fatal  dose  for  an  adult  is  about  a  fluid  drachm  ;  for  an  infant, 
half  this  quantity ;  but  the  danger  depends  more  on  the 
degree  of  concentration  than  upon  the  absolute  quantity 
swallowed.  Death  usually  occurs  within  twenty-four  hours, 
and  in  cases  where  its  action  is  spent  upon  the  rima  glottidis, 
producing  suffocation,  the  fatal  result  may  be  almost  im- 
mediate. According  to  Casper,  the  bodies  of  those  poisoned 
by  sulphuric  acid  resist  putrefaction  for  a  long  period. 

There  seems  to  be  reason  for  believing  that  this  acid 
is  absorbed  into  the  circulation  and  eliminated  by  the 
secretions. 

"Vitriol  throwing" — that  is,  the  throwing  of  strong  sul- 
phuric acid  on  the  person  of  another — occurs  occasionally, 
the  motive  being  generally  revenge  or  jealousy.  Much 
local  injury  is  often  produced.  Copious  effusion  with  water 
is  the  best  treatment. 

Analytic  Methods. — The  concentrated  acid  is  recognized 
by  its  oily  appearance  ;  it  chars  organic  bodies  ;  it  evolves 
considerable  heat  when  mixed  with  an  equal  bulk  of  water. 
The  diluted  acid  is  easily  detected  by  its  producing,  with 
barium  chlorid,  a  white  precipitate  insoluble  in  nitric  acid. 
To  confirm  this  result,   the  precipitate  (barium  sulphate) 


SULPHURIC    ACID TOXICOLOGIC    EXAMINATION.       41/ 

should  be  dried  and  mixed  with  some  reducing  agent 
(charcoal,  potassium  ferrocyanid),  and  heated  to  redness  ; 
the  barium  sulphate  is  by  this  means  converted  into  the 
sulphid,  and  when  this  is  moistened  with  diluted  hydro- 
chloric acid  the  smell  of  hydrogen  sulphid  is  at  once  per- 
ceived, proving  the  presence  of  sulphur. 

Several  other  acids  besides  sulphuric  give  white  precipi- 
tates with  barium  salts,  but  nitric  or  hydrochloric  acids  will 
dissolve  these,  while  the  sulphate  remains  unaffected. 

Any  sulphate  will  produce  the  same  precipitate  with 
barium  chlorid  as  the  free  acid.  The  two  may  easily  be 
distinguished  by  heating  a  little  of  the  liquid  in  a  watch- 
glass  over  a  steam-bath.  Sulphuric  acid  does  not  dry  up, 
while  a  solution  of  a  sulphate  will  form  crystals.  The  solu- 
tion contains  both  the  free  acid  and  some  soluble  sulphate  ; 
finely  powdered  barium  carbonate  should  be  added,  first 
warming  the  liquid  ;  this  will  precipitate  the  free  sulphuric 
acid  only ;  hence  the  resulting  barium  sulphate  will  repre- 
sent all  the  free  acid  present. 

Another  deHcate  test  is  veratrin.  A  small  portion  of  this 
alkaloid  is  introduced  into  the  diluted  acid  and  carefully 
evaporated  to  dryness  ;  a  beautiful  crimson-purple  color  is 
developed.  Moreover,  as  this  test  produces  no  effect  upon 
a  sulphate,  it  serves  to  distinguish  the  latter  from  the  free 
acid. 

Toxicologic  Examinatio7t. — The  organic  matters,  if  thick 
and  viscid,  should  be  boiled  with  the  addition  of  distilled 
water  and  the  solution  filtered,  and  a  measured  portion, 
acidified  by  hydrochloric  acid,  precipitated  hot  by  barium 
chlorid,  and  the  precipitate  washed  and  dried.  This  pre- 
cipitate may  be  reduced  by  heat  and  potassium  ferrocyanid, 
and  further  tested  as  mentioned  above. 
35 


41 S  TOXICOLOGY. 

It  might  happen  that  the  solution  contained  a  soluble 
sulphate  along  with  some  other  acid  —  citric,  acetic,  etc. 
The  mode  of  distinguishing  this  from  a  solution  containing 
free  sulphuric  acid  is  as  follows  :  a  given  volume  of  the 
solution  is  acidulated  with  acid,  and  precipitated  with 
barium  chlorid,  and  the  precipitate  washed,  dried,  and 
weighed.  An  equal  volume  of  the  original  solution  is 
evaporated  to  dryness,  and  heated  in  order  to  drive  off  any 
free  sulphuric  acid,  and  is  then  dissolved  in  pure  water, 
filtered  and  precipitated  as  before,  and  the  dried  deposit 
weighed.  If  the  weight  of  each  of  these  precipitates  is 
equal,  there  was  no  free  sulphuric  acid  present ;  but  if  the 
weight  of  the  former  precipitate  exceeds  that  of  the  latter 
one,  then  the  excess  of  weight  will  indicate  exactly  the 
amount  of  the  free  acid  present  in  the  original  solution. 
The  evaporation  of  sulphuric  acid  must  be  conducted  under 
good  ventilation,  as  a  few  drops  of  it  will  render  a  large 
room  almost  uninhabitable. 

Tardieu  and  Roussin  recommend  the  following  process 
(which  is  also  adopted  by  Blyth)  for  determining  free  sul- 
phuric acid  when  associated  with  a  sulphate.  The  object  is 
to  saturate  the  free  acid  with  a  base,  the  sulphate  of  which 
is  soluble  in  alcohol  :  this  base  is  quinin.  To  a  measured 
portion  of  the  suspected  solution,  quinin,  recently  precipi- 
tated and  washed,  is  added  in  slight  excess,  and  the  whole 
evaporated  on  a  water-bath.  The  semi-liquid  extract  which 
remains  is  exhausted  with  absolute  alcohol ;  the  alcoholic 
solution  is  evaporated,  filtered,  and  evaporated  anew,  and 
the  resulting  extract  dissolved  out  in  a  small  quantity  of 
boihng  distilled  water,  and  immediately  filtered.  If  the 
amount  of  free  sulphuric  acid  is  at  all  considerable,  the 
quinin  sulphate  crystallizes  out  on  cooling  ;    but  if  small, 


NITRIC    ACID.  419 

and  in  either  case,  the  presence  of  the  acid  can  be  proven 
by  the  barium  test. 

It  may  happen  that  in  consequence  of  the  alkahne  anti- 
dotes administered  all  the  acid  will  have  been  neutralized, 
and  only  sulphates  be  found  in  the  vomit  and  in  the  stomach. 
In  such  a  case  it  will  be  impossible  for  the  toxicologist  to 
prove  by  the  analyses  alone  the  fact  of  poisoning  by  sul- 
phuric acid,  since  in  the  ordinary  contents  of  the  stomach 
and  bowels  sulphates  are  always  present.  Consequently, 
futher  evidence  of  the  poisoning  must  be  sought  for  in 
the  symptoms,  post-mortem  lesions,  and  attendant  circum- 
stances. 

Detection  of  Stains  on  Clothing.  —  The  color  of  the  stains 
made  by  sulphuric  acid  on  dark  cloth  is  at  first  red  and 
later  brownish,  and  they  may  retain  moisture  for  a  long 
time.  The  moisture  adherent  to  the  charred  hole  made  by 
this  acid  in  clothing  will  distinguish  it  from  one  made  by  a 
heated  body,  which  is  always  dry.  To  recognize  the  acid, 
a  few  of  these  spots  should  be  cut  out  of  the  garment  and 
boiled  with  a  little  distilled  water  and  tested  with  the  barium 
chlorid.  A  portion  of  the  unaffected  cloth  should  also  be 
tested  at  the  same  time  in  order  to  show  the  absence  of  any 
sulphate. 

Quantitatiz'e  Analysis.  —  Sulphuric  acid  is  estimated  as  a 
sulphate ;  the  precipitated  barium  sulphate,  after  careful 
washing  in  hot  water,  with  a  little  hydrochloric  acid,  is  col- 
lected on  a  filter,  dried,  and  weighed  ;  1 00  parts  of  the  sul- 
phate are  equal  to  42.02   parts  of  sulphuric  acid  (H,SOJ. 

Nitric  Acid  {Aqua  Fortis).  — As  found  in  commerce,  this 
is  a  powerful^ acid,  of  a  yellow  or  orange  color.  Sp.  gr., 
1.35  to   1.45.     It  is  apt  to  be  contaminated  with  sulphuric 


420  TOXICOLOGY. 

acid,  chlorin,  iron,  and  various  nitrogen  oxids.  It  is  seldom 
used  as  a  posion.  Orfila  relates  a  case  where  a  man  poured 
this  acid  into  the  ear  of  his  drunken  wife,  which  caused  her 
death  by  inflammation  of  the  brain  and  destruction  of  the 
bones  seven  weeks  afterward.  This,  however,  might  not 
be  regarded  as  an  instance  of  poisoning. 

Symptoms.  —  Similar  to  those  caused  by  sulphuric  acid, 
except  that  the  lips,  tongue,  and  inside  of  the  mouth  are 
stained  yellow.  Spots  upon  the  cheeks,  neck,  and  other 
parts  of  the  body,  and  of  the  dress,  are  also  yellow  and  very 
permanent.  The  teeth  are  white,  but  yellowish  at  their 
junction  with  the  gums.  The  purging  is  sometimes  accom- 
panied with  blood.  The  vapors  of  this  acid  have  caused 
death  in  seven  instances. 

Fatal  Dose. — Two  drachms  of  the  concentrated  acid  have 
proved  fatal  to  an  adult,  although  larger  doses  have  been 
taken  with  impunity.  Life  is  usually  destroyed  within 
twenty-four  hours,  but  frequently  it  is  protracted,  and  in 
one  case  death  did  not  occur  for  seven  months. 

Treatment.  —  This  is  essentially  the  same  as  that  recom- 
mended for  sulphuric  acid. 

Post-mortcui  Appearances.  —  The  lips,  tongue,  and  inside 
of  the  mouth  present  a  yellow  or  yellowish-brown  appear- 
ance ;  the  mucous  membrane  of  the  esophagus  is  colored 
yellow,  softened,  and  peels  off  in  pieces  ;  the  larynx  and 
glottis  may  have  suffered,  as  in  the  case  of  sulphuric  acid. 
The  stomach  may  be  distended,  presenting  a  greenish  color, 
due  to  the  action  of  the  acid  on  the  bile  ;  it  may  be  found 
in  a  pulpy  state,  perforated,  and  adherent  to  the  adjacent 
viscera,  and  even  partially  destroyed.  The  contents  have 
usually  a  yellow  color  ;  the  lining  membrane  is  deeply  con- 
gested and  the  vessels  filled  with  dark  blood ;  sometimes 


NITRIC    ACID ANALYTIC    METHODS.  421 

the  open  mouths  of  the  vessels  can  be  seen.  The  upper 
portions  of  the  intestines  may  exhibit  the  same  appearances 
as  the  stomach.  The  large  intestine  is  apt  to  escape.  In 
chronic  poisoning  there  is  great  emaciation ;  and,  after 
death,  contraction  of  the  pylorus,  with  softening  of  the 
mucous  membrane,  has  been  found. 

Analytic  Methods. — The  concentrated  acid  is  recognized 
by  (i)  the  odor  when  exposed  to  the  air;  (2)  by  leaving 
no  residue  when  heated  in  a  watch  glass  ;  (3)  by  giving  off  _ 
dense  orange-red  fumes  when  poured  on  fragments  of  cop- 
per (the  dilute  acid  requires  to  be  boiled  on  these  metals  to 
produce  the  same  result) ;  (4)  by  producing  a  brown  color 
with  a  strong  solution  of  ferrous  sulphate. 

The  dilute  acid  is  tested  as  follows  :  (i)  add  barium 
chlorid  and  silver  nitrate  to  separate  portions  of  the  sub- 
stance ;  no  precipitates  will  form.  (2)  Boil  with  fragments 
of  copper ;  red  fumes  will  be  evolved.  (3)  Neutralize  with 
potassium  carbonate  and  moisten  a  piece  of  filtering  paper 
in  the  resulting  solution  (potassium  nitrate) ;  when  the 
paper  is  dried  it  will  scintillate  on  burning,  like  touch-paper. 
(4)  Evaporate  the  above  solution  until  crystallization  ;  ex- 
amine the  crystals  with  a  magnifier  (potassium  nitrate  forms 
six-sided  striated  prisms).  If  the  solution  be  neutralized 
with  sodium  carbonate  the  crystals  will  present  the  cubic 
form  of  sodium  nitrate.  (5)  Put  a  fragment  of  these  crys- 
tals into  a  small  test-tube  along  with  a  little  copper  filings 
and  a  few  drops  of  sulphuric  acid  and  water ;  slightly  heat, 
when  there  will  be  an  escape  of  orange-red  fumes  and  the 
production  of  a  blue  liquid  (copper  nitrate).  (6)  Proceed 
as  in  (5),  but  instead  of  copper  filings  add  a  fragment  of 
morphin,  when  an  orange-colored  solution  will  result,  the 
color  becoming  fainter  on  boiling.      (7)  As  in  (5),  substitut- 


422  TOXICOLOGY, 

ing  for  the  copper  a  crystal  of  brucin,  which  will  yield  a 
blbod~red  color,  disappearing  on  the  addition  of  stannous 
chlorid.  (8)  Proceed  as  in  (5),  except,  instead  of  using 
copper  fiHngs,  add  an  excess  of  sulphuric  acid  and  allow  it 
to  cool ;  then  pour  in  gently  a  freshly-prepared  solution  of 
ferrous  sulphate ;  a  brown  color  is  immediately  formed  at 
the  line  of  junction  ;  if  heated,  the  color  disappears  with 
the  evolution  of  the  orange-red  fumes.  (9)  As  in  (5),  using 
a  crystal  of  narcotin  instead  of  copper ;  a  reddish-brown 
color  is  produced,  changing  by  gentle  heat  to  a  blood-red. 
(10)  If  a  small  portion  of  the  crystals  obtained  in  (4)  be 
mixed  with  a  solution  of  phenol  in  strong  sulphuric  acid, 
heated  gently  for  a  few  minutes  in  a  steam-bath,  diluted 
with  water,  and  neutralized  by  sodium  hydroxid,  a  yellow 
solution  of  sodium  picrate  will  be  obtained. 

Toxicologic  Exaviination.  —  First,  test  the  organic  matters 
(as  contents  of  the  stomach,  etc.)  with  litmus  paper  ;  the 
acid  may  have  been  neutralized  by  the  alkaline  antidotes. 
If  viscid,  add  a  sufficient  quantity  of  distilled  water  and  boil 
gently  for  about  a  quarter  of  an  hour ;  filter ;  if  found  to 
be  acid,  a  trial  test  may  first  be  made  by  boiling  a  portion 
of  it  in  a  test-tube  with  copper  filings  ;  it  may  next  be 
neutralized  with  potassium  carbonate  and  crystallized  by 
evaporation ;  drench  the  crystals  with  strong  alcohol  to 
remove  impurities,  and  test  them  by  the  methods  above  de- 
scribed. If  the  matters  examined  are  not  acid,  but  have 
been  neutrahzed  by  chalk  or  magnesia,  the  nitrates  so  pro- 
duced may  be  decomposed  by  potassium  carbonate  and  the 
resulting  potassium  nitrate  strained  from  the  filtered  solution. 

The  urine  should  always  be  examined  for  nitrates  by  dis- 
tillation with  sulphuric  acid,  neutralizing  the  distillate  with 
potassium  carbonate  and  proceeding  as  above. 


HYDROcfitdRic  Acid.  423 

The  tissues  may  be  examined  as  follows  :  Make  a  mixture 
of  equal  parts  of  sulphuric  acid  and  water,  and  put  twenty 
or  thirty  drops  into  test-tubes. 

To  (i)  add  a  little  brucin  ;  no  change  should  result. 
Add  now  a  little  piece  of  the  tissue  to  be  examined,  when 
the  solution,  if  nitric  acid  be  present,  will  turn  a  blood-red 
color. 

To  (2)  add  a  few  grains  of  copper  filings  and  a  piece  of 
the  tissue,  and  boil.  The  evolved  reddish  vapors,  if  nitric 
acid  be  present,  will  give  a  blue  color  to  a  piece  of  white 
paper  moistened  with  a  solution  of  potassium  iodid  and 
starch. 

To  (3)  add  a  solution  of  ferrous  sulphate  ;  on  adding  a 
piece  of  the  tissue,  the  solution  will  become  of  an  olive- 
brown  color  if  nitric  acid  be  present. 

Suspected  stains  are  examined  by  soaking  the  fabric  or 
other  substance  in  warm  distilled  water.  If  acid,  the  solu- 
tion should  be  neutralized  with  potassium  carbonate,  and 
the  resulting  crystals  treated  as  above  directed.  The  color 
of  these  stains,  as  before  mentioned,  is  yellow  ;  they  can  be 
distinguished  from-  stains  of  iodin  and  bile  by  the  applica- 
tion of  a  weak  solution  of  potassium  hydroxid,  which  in- 
tensifies the  nitric  stain,  whilst  it  discharges  the  iodin  (or 
bromin)  stain,  and  does  not  affect  the  bile. 

Hydrochloric  Acid.  —  This  acid,  known  commercially 
as  Muriatic  Acid  and  Spirit  of  Salt,  as  usually  found  has  a 
light  yellow  color,  fumes  when  exposed  to  the  air,  is  power- 
fully acid,  and  has  a  sp.  gr.  of  about  1.15.  When  pure  it 
is  colorless  ;  its  yellow  hue  is  due  to  ferric  chlorid  or  or- 
ganic matter.  The  commercial  acid  frequently  contains 
arsenic  and  antimony  and  other  impurities.      Instances  of 


424  TOXICOLOGY. 

poisoning  by  it  afe  comparatively  rare,  except  as  the  result 
of  accident. 

Symptoms.  —  These  are,  generally,  similar  to  those  occa- 
sioned by  the  other  mineral  acids.  A  grayish  or  white 
appearance  of  the  tongue  and  interior  of  the  mouth,  with 
the  formation  of  a  false  membrane,  is  usually  observed. 

Fatal  Dose.  —  Half  an  ounce  for  an  adult ;  a  drachm  has 
destroyed  a  child.  T\\q  fatal  period  wds'iQS  from  a  few  hours 
to  many  weeks. 

The  treatment  is  the  same  as  that  above  described  for  the 
other  mineral  acids. 

Post-mortem  Appearances.  —  These,  on  the  whole,  resem- 
ble the  lesions  found  in  cases  of  death  from  the  other  two 
acids,  although  they  more  closely  assimilate  the  appearance 
produced  by  sulphuric  acid,  in  the  blackened  or  charred 
ridges  often  noticed  in  the  interior  of  the  stomach.  The 
esophagus  presents  a  denuded  appearance  from  the  detach- 
ment of  its  mucous  membrane.  The  glottis  and  laiynx 
may  also  be  deeply  injected  and  corroded  in  cases  where 
the  poison  has  spent  its  effects  on  these  organs. 

Analytic  Methods.  —  The  strong  acid  is  distinguished  from 
other  acids  (i)  by  its  yellow  color ;  (2)  by  its  giving_off 
dense  white  fumes  in  contact  with  ammonium  hydroxid, 
shown  by  holding  the  stopper  of  the  ammonium  hydroxid 
bottle  over  the  solution  supposed  to  contain  the  acid ;  (3) 
by  its  negative  action  on  copper  or  mercury,  even  when 
heated ;  (4)  by  its  evolving  chlorin  when  heated  with  niaiv- 
ganese  dioxid. 

The  dilute  acid  is  detected  by  a  solution  of  silver  nitrate, 
which  gives  a  white,  curdy  precipitate  of  silver  chlorid  that 
soon  darkens  on  exposure  to  light,  is  insoluble  in  boiling 
nitric    acid,  but    very    soluble    in    ammonium    hydroxid. 


HYDROCHLORIC    ACID.  "  425 

When  dried  and  heated  it  fuses  into  a  yellow  liquid,  which 
on  cooling  becomes  a  soft,  horny  mass.  As  any  soluble 
chlorid  —  e.  g.,  common  salt  —  will  yield  the  same  precipi- 
tate with  silver  nitrate,  a  drop  of  the  original  solution  should 
be  evaporated  on  a  glass  slide  ;  if  it  was  free  acid  it  will  all 
disappear ;  if  a  chlorid,  a  residue  will  be  left. 

Silver  nitrate  forms  precipitates  with  other  substances  ; 
but  all,  with  the  exception  of  that  from  cyanids,  dissolve  in 
nitric  acid.  The  silver  cyanid  is  soluble  in  boiling  nitric 
acid,  and  is  further  distinguished  by  its  crystalline  appear- 
ance, and  by  yielding,  when  heated,  cyanogen  gas. 

Toxicologic  Examination.  — As  this  acid  is  volatile,  a  dis- 
tilling process  may  be  applied.  The  organic  matters  (such 
as  the  contents  of  the  stomach,  together  with  the  viscera, 
properly  cut  up)  should  be  put  into  a  glass  retort  with  a 
small  quantity  of  pure  water,  and  distilled  nearly  to  dryness. 
The  first  portion  of  the  distillate  may  be  rejected,  but  the 
remainder  will  usually  yield  the  characteristic  test  with 
silver  nitrate. 

The  above  method,  however,  is  liable  to  two  fallacies  : 
First,  there  is  always  apt  to  be  present  in  the  gastric  juice 
of  the  human  stomach  a  variable  quantity  of  hydrochloric 
acid ;  and,  secondly,  sodium  chlorid  is  frequently  found 
there,  being  introduced  with  the  food.  Consequently,  it 
will  not  be  safe  to  rest  the  proof  of  poisoning  by  hydro- 
chloric acid  on  the  analysis  exclusively.  If  the  symptoms 
and  post-mortem  lesions  do  not  indicate  death  from  a  cor- 
rosive acid,  the  mere  detection  of  this  acid,  after  death,  by 
the  chemical  examination  would  be  of  no  value. 

The  stains  of  hydrochloric  acid  on  dark  cloth  are  at  first 
of  a  bright  red  color,  changing,  after  some  days,  to  a  red- 
dish-brown. They  may  be  examined  after  the  method 
36 


426  TOXICOLOGY. 

already  described.  The  experiment  should,  however,  be 
verified  by  testing  another  portion  of  the  garment  not  hav- 
ing a  stain. 

This  acid  is  sometimes  used  to  erase  ink  marks  in  cases 
of  forgery.  The  paper  thus  acted  on  should  be  treated  in 
the  same  manner  as  mentioned  for  the  cloth. 

Hydrochloric  acid  is  estimated  as  silver  chlorid,  every 
I  GO  parts  of  the  latter  are  equivalent  to  about  80  parts  of 
acid  of  sp.  gr.  1,15. 

ALKALIES  AND  THEIR  SALTS. 

The  toxicology  of  the  three  alkalies,  Potassium  Hy- 
droxid,    Sodium   Hydroxid,    and  Ammonium   Hydroxid, 

may  properly  be  considered  together.  Their  effects  upon 
the  animal  system  are  analogous,  and  resemble  the  impres- 
sions produced  by  the  mineral  acids,  being  powerfully 
caustic  in  their  concentrated  state.  They  attack  the  tissues 
with  which  they  come  in  contact  by  virtue  of  their  chemical 
affinities,  causing  their  disorganization  and  complete  destruc- 
tion. They  are  veiy  rarely  used  for  homicidal  poisoning, 
but  they  occasionally  prove  fatal  as  the  result  of  accident. 

Potassium  hydroxid  is  commonly  known  as  caustic 
potash  or  potassa ;  sodium  hydroxid  is  known  as  caustic 
soda  and  concentrated  lye. 

The  Aqua  AmmonicE  of  the  shops  is  a  solution  of  ammo- 
nium hydroxid  in  water,  and  is  a  highly  caustic  substance. 
The  first  two  alkalies,  together  with  their  salts,  are  fixed 
when  heated  ;  the  latter  is  volatilized  by  heat,  by  which 
circumstance  they  are  readily  distinguished  from  each 
other. 

Syviptonis.  —  In  the  concentrated  state  they  occasion  an 
acrid,  nauseous  taste,  followed  by  a  burning  sensation  in  the 


Alkalies  and  their  salts.  42^ 

throat  and  stomach  ;  violent  abdominal  pain,  increased  by 
pressure  ;  vomiting  of  mucous  matters,  tinged  with  blood  ; 
purging  of  a  similar  character,  with  tenesmus  ;  difficulty  of 
swallowing,  hoarseness,  and  coughing.  The  pulse  is  quick 
and  feeble,  the  countenance  anxious  ;  the  body  is  covered 
with  a  cold,  clammy  sweat ;  the  respiration  is  rapid,  with 
great  muscular  protraction.  Death  may  ensue  in  a  few 
hours,  or  it  may  be  postponed  for  months,  or  even  years. 
In  the  latter  cases  the  fatal  result  is  often  owing  to  sec- 
ondary causes,  such  as  stricture  of  the  esophagus  and  of  the 
pylorus,  occasioning  starvation. 

The  effects  of  swallowing  strong  ammonium  hydroxid 
are  similar  to  those  above  described,  except  that  they  may 
be  more  rapid,  and  effect  the  organs  of  respiration  by  the 
vapor  given  off 

The  incautious  application  of  this  vapor  to  the  nose,  in 
cases  of  syncope,  is  sometimes  followed  by  fatal  results  for 
this  same  reason. 

Fata.1  Dose. — As  in  the  case  of  the  mineral  acids,  the  fatal 
effects  of  the  alkalies  depend  rather  upon  their  degree 
of  concentration  than  upon  the  actual  amount  swallowed. 
Half  an  ounce  of  potassium  hydroxid  is  the  usual  fatal  dose  ; 
but  an  ounce  and  a  half  of  the  solution  of  the  shops,  con- 
taining about  forty  grains,  has  caused  death.  Strong  am- 
monium hydroxid  has  proved  fatal  in  the  dose  of  two 
drachms  ;  recovery  has  occurred  after  swallowing  over  an 
ounce.  Instances  of  recovery  are  more  frequent  from  this 
than  from  the  fixed  alkalies. 

Treatment.  —  The  stomach-pump  should  never  be  used. 
Dilute  vinegar  or  lemon  juice  should  be  freely  given, 
together  with  oil  or  other  demulcents.  Opium  may  be 
used  to   quiet  pain,  and  stimulants  to   counteract  the  de- 


428  TOXICOLOGY. 

pression.  The  inhalation  of  acetic  acid  might  prove  bene- 
ficial in  poisoning  by  vapor  of  ammonium  hydroxid. 

Post-ino7'tein  Appearances. — The  lining  membranes  of  the 
mouth,  throat,  esophagus,  and  stomach  exhibit  evidences 
of  corrosion  in  their  softened  and  abraded  condition ;  at 
times  the  mucous  coat  of  the  stomach  is  blackened  from 
the  effused  blood,  and  may  be  completely  destroyed.  The 
larynx  and  bronchi  may  be  inflamed  and  softened,  espe- 
cially with  ammonium  hydroxid.  In  chronic  cases  the 
mucous  membrane  of  the  esophagus  may  be  much  thick- 
ened, and  its  caliber,  as  also  that  of  the  pylorus  of  the 
stomach,  extremely  contracted. 

Chemical  Properties.  —  All  the  alkalies  neutralize  acids, 
turn  turmeric  paper  brown,  and  restore  the  blue  to  red- 
dened Htmus.  They  are  not  precipitated  by  hydrogen  sul- 
phid,  ammonium  sulphid,  or  ammonium  carbonate.  Cor- 
rosive sublimate  causes  a  yellowish  precipitate  with  the 
fixed  alkalies  and  a  white  one  with  ammonium  hydroxid. 

Potassium  hydroxid  is  distinguished  from  sodium  hy- 
droxid as  follows  : 

1.  Platinum  chlorid produces,  with  the  former,  a  yellow 
potassium  platinum  chlorid  which,  under  the  microscope, 
is  seen  to  be  in  octahedral  crystals.  This  reagent  will  also 
precipitate  ammonium  compounds  ;  hence,  in  an  analysis, 
the  absence  of  the  latter  must  be  insured.  Ammonium  can 
readily  be  detected  by  heating  a  little  of  the  suspected 
liquid  in  a  test-tube  with  lime  or  magnesia  ;  the  vapor  may 
be  recognized  by  its  odor  and  by  its  action  on  turmeric 
paper. 

2.  Tartaric^^cid^throws  down  from  a  strong  solution  of 
potassa,  or  its  salts,  a  white  crystalline  precipitate  —  potas- 
sium  acid  tartrate.     This  action  should  be  facilitated  by 


TESTS     FOR     AMMONIUM     SALTS.  429 

adding  a  little  alcohol  and  stirring  with  a  glass  rod.  Here, 
also,  the  absence  of  ammonium  compounds  must  first  be 
proved. 

3.  Neutralize  the  solution  with  nitric  acid  and  evaporate 
on  a  steam  water-bath.  The  resulting  crystals  are  readily 
identified.  Potassium  nitrate  is  in  six-sided  striated  prisms  ; 
sodium  nitrate  in  cubes. 

4.  Heated  on  a  loop  of  platinum  wire  in  the  Bunsen- 
burner  flame,  potassium  compounds  give  a  violet  flame, 
sodium  compounds  a  yellow  flame.  The  spectroscope 
easily  distinguishes  the  two  bodies  in  presence  of  each 
other.  Sodium  gives  a  yellow  line,  which  is  double  when 
examined  with  a  good  instrument.  Potassium  gives  two 
lines,  one  dark  red  and  the  other  violet. 

Since  sodium  compounds  occur  abundantly  in  many 
animal  fluids,  especially  blood  and  urine,  and  potassium 
compounds  are  also  present,  it  is  obvious  that  the  finding 
simply  of  these  elements  in  combination  will  not  prove 
poisoning.  It  must  be  shown  either  that  the  amount  is 
much  larger  than  normal  or  that  compounds  not  normal  to 
the  body  are  present. 

Toxicologic  Examinations.  —  If  required  to  separate  a 
hydroxid  from  the  carbonate,  the  original  mixture  must 
first  be  evaporated  to  dryness,  and  the  residue  treated  with 
absolute  alcohol,  which  will  dissolve  out  the  hydroxid  but 
not  the  carbonate.  After  filtration,  evaporate  to  dryness 
and  incinerate  ;  dissolve  the  residue  in  water  and  test  as 
above  directed. 

Quantitative  Determination.  —  Potassium  is  estimated  by 
mixing  its  chlorid  with  excess  of  an  alcoholic  solution  of 
platinum  chlorid.  The  precipitate  should  be  washed  with 
strong  alcohol,  dried,  and  weighed.      Every  100  parts  of  the 


430  TOXICOLOGY. 

double   chlorid  represents  23  parts  of  potassium   hydro xid, 
or  28.3  parts  of  carbonate. 

Solution  of  ammonium  hydroxid  {Aqua  Auivionioe)  is  a 
colorless  liquid  having  a  very  pungent  odor  and  an  acrid, 
alkahne  taste.  It  leaves  no  residue  when  evaporated  to 
dryness.  It  gives  to  a  solution  of  a  copper  salt  a  charac- 
teristic blue  color.  It  produces  white  fumes  with  hydro- 
chloric acid. 

The  salts  of  ammonium  are  colorless,  and  volatilize  when 
heated ;  and  if,  at  the  same  time,  they  are  mixed  with  lime 
or  potassium  hydroxid,  they  yield  the  characteristic  ammo- 
niacal  odor.  The  other  tests  for  ammonium  salts  are  :  (i) 
platinum  chlorid  ;  (2)  tartaric  acid ;  (3)  Nessler's  reagent. 
The  last  is  made  by  adding  an  excess  of  potassium  iodid  to 
mercuric  chlorid  until  the  mercuric  iodid  formed  is  redis- 
solved,  an  excess  being  afterward  added.  It  gives  an 
orange  or  brownish  discoloration,  with  the  smallest  trace  of 
ammonium  compounds. 

Toxicologic  Examination.  —  If  the  mixture  be  in  a  state  of 
decomposition,  it  will  be  useless  to  attempt  the  analysis, 
inasmuch  as  ammonium  compounds  are  invariable  as  a 
result  of  putrefactive  processes.  Distil  over  about  a  fourth 
of  the  organic  liquid,  conducting  the  vapors  into  a  well- 
cooled  receiver  containing  a  little  water,  and  test  the  solu- 
tion as  above  directed.  If  no  ammonium  hydroxid  be 
given  off,  then  examine  the  contents  of  the  retort  for  an 
ammonium  salt,  by  first  treating  with  strong  alcohol ;  filter 
the  solution  and  re-distil,  along  with  slacked  lime  or  sodium 
hydroxid  ;  this  will  yield  the  ammonium  hydroxid. 

Ammonia  is  determined,  quantitatively,  like  potassium  : 
every  100  parts  of  the  double  chlorid  represent  16.5  parts 
of  ammonium  hydroxid. 


POTASSIUM    NITRATE.  43 1 

Potassium  Nitrate  {Niter,  Saltpeter).  —  This  salt  is 
much  used  in  the  arts,  especially  for  the  manufacture  of 
gunpowder ;  it  is  likewise  employed  in  medicine  in  small 
doses.  It  occurs  in  six-sided,  striated  crystals  ;  taste  saline 
and  cooling ;  very  soluble  in  water ;  deflagrates  when 
thrown  upon  hot  coals  ;  gives  off  nitrous  fumes  when  acted 
upon  by  sulphuric  acid. 

Symptonis. — In  large  doses,  and  in  the  concentrated  state, 
it  acts  as  a  powerful  irritant  to  the  alimentary  mucous 
membrane,  causing  violent  burning  pain  in  the  esophagus 
and  stomach  ;  vomiting,  sometimes  of  blood ;  bloody  stools  ; 
cold,  clammy  skin ;  weak,  frequent  pulse ;  collapse  and 
death.  Besides  these  evidences  of  a  local  irritant  action,  it 
occasions  certain  nervous  symptoms,  such  as  convulsions, 
tremors,  partial  paralysis,  loss  of  speech,  and  delirium. 
Occasionally,  a  very  large  dose  has  produced  compara- 
tively slight  local  symptoms,  while  the  impression  upon 
the  nervous  centers  has  been  more  decided. 

Fatal  Dose. — Death  from  this  compound  is  generally  the 
result  of  accident,  it  having  been  swallowed  by  mistake  for 
other  salts.  An  ounce  to  an  ounce  and  a  half,  taken  in  a 
concentrated  state,  has  frequently  proved  fatal  in  a  few 
hours.  The  largest  dose  recorded  to  have  been  taken  is 
mentioned  by  Warton  and  Stille.  A  German,  by  mistake, 
swallowed  three  and  a  half  ounces  of  this  salt.  He  com- 
plained of  but  slight  pain  or  sense  of  heat  in  the  stomach, 
and  was  purged  three  times  within  three  or  four  hours. 
About  five  hours  after  taking  the  niter  he  suddenly  fell  out 
of  his  chair  and  expired.  There  was  no  autopsy.  In  this 
case  the  excessive  dose  of  the  poison  seemed  to  have  de- 
stroyed life  by  shock.  The  rigor  mortis  was  veiy  im- 
perfect, and  the  countenance  and  lips   retained  their  life- 


432  TOXICOLOGY. 

like  appearance  to  a  remarkable  degree  for  three  days  after 
death. 

Post-mortem  Appearances. — The  lining  membrane  of  the 
stomach  is  usually  highly  inflamed  and  detached  in  places  ; 
perforation  has  been  observed  in  one  instance.  The  in- 
testines are  often  similarly  affected.  The  contents  of  the 
stomach  are  sometimes  tinged  with  blood. 

Treatment.  —  Free  vomoting  should  be  promoted  by  the 
use  of  bland  mucilaginous  drinks  ;  opium  and  stimulants 
to  relieve  pain  and  depression ;  together  with  external 
applications,  as  fomentations,  etc.  There  is  no  chemical 
antidote. 

Toxicologic  Examination.  — See  Nitric  Acid.  — According 
to  Orfila  and  Wohler,  niter  has  been  detected  in  the  urine, 
liver,  spleen,  and  kidneys  of  those  poisoned  by  it. 

Potassium  Chlorate. — This  salt,  so  much  used  in  medi- 
cine of  late  years,  has  not  infrequently  been  the  cause  of 
death.  Half  an  ounce  has  proved  fatal  to  an  adult.  The 
symptoms  are  those  of  a  powerful  irritant  to  the  alimentaiy 
canal  and  nervous  systems,  such  as  vomiting  and  purging, 
general  weakness,  with  rigidity  of  the  limbs,  delirium,  and 
coma.  After  death  the  blood  has  been  found  of  a  brown- 
ish color,  thickened,  with  a  tendency  to  agglutination  of 
the  corpuscles.  The  urine  contains  blood  corpuscles  and 
brownish  tube-casts.  It  has  been  stated  that  crystals  of 
the  substance  has  been  found  in  the  tubes  of  the  kidney 
in  cases  of  poisoning. 

Potassium  Acid  Tartrate  {Cream  of  Tartar^. — This 
salt  is  very  much  used  in  medicine  and  is  not  generally 
considered  to  be  poisonous ;  but  in  large  and  concentrated 


POTASSIUM    SULPHATE.  433 

doses — two  ounces — it  has  proved  fatal,  causing  symptoms 
strongly  resembling  those  produced  by  niter. 

Alum. — This  salt,  in  large  doses,  is  very  irritant  to  the 
stomach  and  bowels,  producing  vomiting  and  purging, 
although  in  small  quantities  its  action  is  that  of  an  astrin- 
gent. It  has  proved  fatal  to  animals,  and  at  least  one  death 
in  the  human  subject  has  been  recorded.  Commercial  alum 
may  be  either  potassium  aluminum  sulphate  or  ammonium 
aluminum  sulphate.  The  physiologic  action  of  each  is 
practically  the  same. 

Potassium  sulphate  and  potassium  acid  sulphate  are 

highly  irritating  in  large  doses  ;  the  former  has  occasioned 
death  in  quantity  of  ten  drachms.  It  is  used  sometimes  as 
an  abortive.  Arsenic  compounds  have  been  found  as  im- 
purities of  the  commercial  article,  and  might  in  this  way  get 
into  Dover's  powder  when  made  by  the  older  method,  in 
which  a  large  proportion  of  potassium  sulphate  was  used. 
The  death  of  a  sailor  occurred  some  years  ago  on  a  German 
steamer  bound  for  Philadelphia,  and  on  arrival  of  the  vessel 
the  German  consul  requested  the  captain  to  submit  to  Dr. 
Henry  Leffmann,  for  analytic  examination,  all  suspicious  ma- 
terials found  among  the  sailor's  effects.  About  half  a  pound 
of  potassium  acid  sulphate  was  found,  and  it  is  not  unlikely 
that  some  of  this  substance  had  been  taken,  possibly  by  mis- 
take, although  there  was  suspicion  of  suicide.  The  symp- 
toms were  those  of  an  irritant. 

Large  doses  of  the  ordinaiy  purgative  salts  under  certain 
circumstances  may  prove  powerfully  irritating,  and  even 
fatal.  Instances  of  death  following  the  administration  of 
overdoses  of  Epsom  salt  and  common  salt  are  reported  by 
Christison  and  Taylor. 


434  TOXICOLOGY. 

Chlorinated  Soda  and  Potassa.  —  Known  in  commerce 
as  Labarraque's  solution  and  Javelle  water,  respectively,  and 
much  used  for  disinfecting  and  cleansing  purposes,  have 
occasionally  produced  fatal  effects  when  swallowed.  Tar- 
dieu  has  reported  such  a  case  in  which  a  child  died  some 
weeks  after  taking  this  substance  in  divided  doses.  It  was 
identified  by  the  discovery  of  an  abnormal  quantity  of 
sodium  chlorid  in  the  urine  and  kidneys  ;  also  by  the  for- 
mation of  lead  chlorid  on  the  leaden  mouth-piece  of  the 
bottle  which  contained  the  poison,  and  likewise  by  charac- 
teristic stains  of  a  reddish-white  color  on  the  child's  cap. 

Barium  Salts.  —  All  the  soluble  compounds  of  barium 
are  poisonous.  They  occasion  symptoms  analogous  to 
those  caused  by  potassium  nitrate,  such  as  pain  in  the 
stomach,  vomiting,  and  purging,  with  decided  nervous  symp- 
toms and  palpitation  of  the  heart.  The  post-mortem  lesions 
are  inflammation  of  the  mucous  coat  of  the  stomach  and 
bowels,  great  congestion  of  the  brain  and  lungs,  and  the 
heart  full  of  dark  blood. 

The  proper  treatment  is  to  promote  the  evacuation  of  the 
poison  by  the  use  of  emetics  and  mucilaginous  drinks  and 
the  free  administration  of  sodium  sulphate  or  magnesium 
sulphate,  and  the  subsequent  use  of  antiphlogistic  remedies. 

IRRITANTS  PROPER. 

This  subdivision  of  the  Irritants  includes  such  poisons 
as,  besides  producing  inflammation  of  the  gastro-intestinal 
mucous  membrane,  cause  other  symptoms,  which  indicate 
an  impression  on  the  great  nervous  centers.  Several  of  the 
alkaline  and  earthy  salts  already  described  are  of  this  char- 
acter, and  might  have  been  considered  under  this  head. 


PHOSPHORUS SYMPTOMS.  435 

PHOSPHORUS. 

Phosphorus,  in  combination,  is  largely  diffused  as  a 
constituent  of  the  animal  body.  Its  presence  is  essential 
to  the  performance  of  its  normal  functions,  and  this  is  espe- 
cially true  in  reference  to  the  great  nerve-centers,  of  which 
it  constitutes  a  comparatively  large  proportional  part.  It 
is  eliminated  from  the  system  in  the  urine  in  the  form  of 
phosphates. 

In  its  free  state  phosphorus  is  a  powerful  irritant  poison. 
It  is  less  employed  for  poisoning  in  this  country  and  Eng- 
land than  in  France  and  Germany,  and  is  seldom  used  for 
homicidal  purposes.  Fatal  results  have  frequently  oc- 
curred by  its  accidental  and  suicidal  employment  —  chiefly 
the  former,  from  the  swallowing  of  phosphorus-paste  (used 
for  destroying  vermin)  and  the  tops  of  lucifer  matches. 

Symptoms.  —  These  do  not  usually  appear  for  some  hours 
after  the  poison  has  been  taken  ;  but  in  some  cases  they  are 
manifested  earlier.  There  is  first  perceived  a  disagreeable 
taste,  and  a  garlicky  odor  may  be  noticed  in  the  breath. 
This  is  followed  by  a  burning  pain  in  the  throat  and  stom- 
ach, with  intense  thirst  and  nausea  ;  distention  of  the  abdo- 
men, with  vomiting  and  purging ;  pupils  dilated ;  cold 
perspiration  and  great  anxiety,  with  small,  frequent,  and 
irregular  pulse.  The  matters  first  vomited  generally  ex- 
hale a  garlicky  odor,  and  are  luminous  in  the  dark  ;  their 
color  is  green,  or  like  coffee  grounds  and  they  may  contain 
the  blue  or  red  fragments  of  the  tops  of  matches.  The  dis- 
charges from  the  bowels  have  also  been  observed  to  be 
phosphorescent.  Sometimes  convulsions  precede  death  ; 
again,  the  patient  may  die  quietly  or  in  a  coma.  If  the 
case  is  protracted  for  some  days,  jaundice  is  apt  to  occur, 
and  likewise  hemorrhage  from  the  stomach,  bowels,  nose, 


43^  TOXICOLOGY. 

and  other  parts  of  the  body.  In  some  of  its  phases  the 
hemorrhagic  form  resembles  scurvy,  and,  as  in  the  latter 
disease,  there  are  purpura  spots  over  the  body.  Paralysis 
is  an  occasional  result.  The  urine  is  highly  albuminous, 
and  is  apt  to  be  suppressed. 

Chronic  poisoning,  accompanied  by  all  the  above  symp- 
toms, though  in  a  less  violent  degree,  may  result  from  the 
inhalation  of  the  vapors  of  phosphorus  in  the  manufacture 
of  lucifer  matches.  This  form  of  poisoning  comes  on  very 
insidiously,  and  is  very  apt  to  be  fatal.  It  generally  mani- 
fests itself  first  in  the  jaws,  causing  first  an  inflammation  of 
the  periosteum,  followed  by  caries  of  the  teeth  and  necrosis 
of  the  bone.  Some  authorities  state  that  this  form  of  ne- 
crosis attacks  only  those  whose  teeth  are  decayed.  It  is 
further  stated  that  in  some  match  factories  it  is  required 
that  the  workmen  should  have  sound  teeth. 

Vollbracht  furnishes  notes  of  a  case  of  poisoning  by 
phosphorus  in  which  symmetrical  gangrene  of  the  feet 
developed.  Death  soon  followed.  The  patient  was  a 
young  woman  who  had  taken  a  mixture  intended  for  tip- 
ping matches.  Vollbracht  refers  to  a  case  reported  by 
Kolisko  in  which  subacute  poisoning  by  phosphorus  was 
followed  by  gangrene  of  the  extremities.  In  judging  of 
these  cases,  it  must  not-  be  forgotten  that  a  mixture  used 
for  tipping  matches  may  contain  other  poisonous  bodies  be- 
sides phosphorus. 

Fatal  Dose.  —  Less  than  a  grain  has  proved  fatal.  Lobel, 
of  Jena,  has  reported  the  case  of  a  lunatic  who  died  from 
taking  about  the  -Jq  of  a  grain.  A  child  died  after  sucking 
two  matches  ;  another  older  child  died  from  the  effects  of 
swallowing  the  tops  of  eight  matches. 

Phosphorus    is    occasionally   employed  in   medicine,    in 


PHOSPHORUS  TREATMENT.  437 

doses  of  J-jj-  to  g-L-  of  a  grain ;  but  even  in  these  small  doses 
its  effects  are  uncertain,  and  it  may  sometimes  act  with  un- 
expected severity. 

Fatal  Period.  —  It  is  not  to  be  classed  among  the  rapidly 
fatal  poisons.  It  usually  causes  death  in  from  one  to  four 
or  five  days  ;  in  exceptional  cases,  earlier.  Casper  quotes 
the  case  of  a  young  lady  who  died  in  twelve  hours  after 
swallowing  three  grains  of  phosphorus  in  the  form  of  an 
electuary.  Dr.  Habershon  reports  a  case  which  proved 
fatal  in  half  an  hour.  Cases  of  chronic  poisoning  may  last 
for  months,  or  even  for  years. 

Treatment.  —  There  is  no  chemical  antidote  known.  Free 
emesis  should  be  encouraged  by  the  use  of  albuminous  and 
mucilaginous  drinks  holding  magnesia  or  magnesium  hy- 
droxid  in  suspension.  Washing  out  the  stomach  with  water 
containing  a  little  potassium  permanganate  (i  to  3  per  cent.) 
is  recommended.  The  use  of  fatty  oils  is  objectionable, 
as  they  are  solvents  for  phosphorus,  and  would  conse- 
quently tend  to  diffuse  the  poison.  Oil  of  turpentine  is 
highly  recommended  by  Dr.  Percy  as  a  reliable  antidote,  if 
given  early  and  before  the  poison  is  absorbed.  The  old  oil, 
or  that  which  has  become  oxygenated,  is  to  be  employed, 
not  the  fresh  hydrocarbon.  He  also  recommends  the  intro- 
duction of  oxygenated  water  into  the  stomach  through  a 
tube,  and  the  inhalation  of  free  oxygen  into  the  lungs. 
Animal  charcoal  has  also  been  recommended,  from  its 
power  of  absorbing  free  phosphorus  ;  and  likewise  silver 
nitrate,  from  its  power  to  form  an  insoluble  compound  of 
silver  and  phosphorus.  Copper  sulphate  also  is  recom- 
mended. These  mineral  salts  are  themselves  irritant 
poisons,  and  can  certainly  be  permissible  only  in  small 
doses. 


438  TOXICOLOGY. 

Post-mortem  Appearances.  —  According  to  Tardieu,  who 
has  given  special  attention  to  this  subject,  the  lesions  pro- 
duced by  phosphorus  vary  according  to  the  form  in  which 
it  is  taken.  It  is  when  in  the  pure  state  or  simply  dissolved 
in  oil  that  it  most  frequently  occasions  lesions  in  the 
esophagus  and  alimentary  canal.  Fragments  of  phosphorus 
may  be  discovered  adhering  to  the  mucous  membrane,  even 
of  the  large  intestines,  and  at  these  spots  the  bowel  is  liable 
to  perforation  during  the  examination.  In  the  esophagus, 
stomach,  and  intestines  ecchymotic  or  gangrenous  spots  are 
scattered  about.  The  mesenteric  glands  are  engorged,  and 
are  often  soft  and  friable. 

The  blood  corpuscles  undergo,  in  phosphorus-poisoning, 
a  speedy  disintegration,  which  is  doubtless  the  cause  of  the 
ecchymoses  seen  upon  the  different  organs. 

In  other  cases,  as  in  poisoning  by  phosphorus-paste, 
there  may  be  no  special  morbid  appearance,  but  even  in  the 
absence  of  redness  or  ulceration  there  will  be  ecchymoses, 
more  or  less  abundant,  over  the  mesentery  and  visceral 
peritoneum.  The  pleural  and  pericardial  sacs  contain 
bloody  serum.  Irregular  bloody  spots  are  scattered  over 
the  pleura,  pericardium,  and  even  the  endocardium.  The 
heart  is  soft,  distended,  or  contains  fluid  blood.  The  blood 
itself  is  very  dark,  fluid,  and  syrupy ;  it  appears  to  be  com- 
pletely devitalized  ;  the  corpuscles  are  disintegrated  and 
transparent,  by  loss  of  their  coloring  matter.  In  certain 
cases  the  mucous  coat  of  the  stomach  and  duodenum  is  so 
softened  as  to  break  under  pressure  of  the  knife  ;  ulcera- 
tions also  sometimes  occur  in  the  stomach.  It  is  stated  that 
the  intestines,  and  even  the  flesh,  of  animals  poisoned  by 
phosphorus  have  the  odor  of  garlic,  and  appear  luminous  in 
the  dark.  This  luminosity  of  the  viscera  has  been  observed 
in  the  human  subject. 


PHOSPHORUS — DIAGNOSIS.  439 

The  exterior  of  the  body  often  exhibits  an  icterode 
appearance.  Sometimes  the  red  or  blue  coloring  matter  of 
the  lucifer  matches  that  have  caused  death  may  be  found^ 
adhering  to  the  inside  of  the  alimentary  canal  a  considerable 
time  after  death.  The  general  appearance  of  the  gastro- 
intestinal mucous  membrane  is  hemorrhagic  rather  than 
inflammatory,  ecchymoses  being  scattered  throughout. 
The  contents  of  the  intestines  are  liquid  and  bloody.  The 
bladder  contains  bloody  urine,  and  often  presents  sub- 
mucous ecchymoses. 

A  peculiar  pathological  alteration  revealed  by  the  micro- 
scope as  the  result  of  phosphorus-poisoning  is  fatty  degen- 
eration of  the  liver  and  other  organs  of  the  body.  But 
these  peculiarities  are  not  absolutely  characteristic  of  this 
poisoning,  since  they  occur  in  poisoning  by  other  agents, 
as  arsenic,  alcohol,  antimony,  etc.,  and  also  as  the  result 
of  disease ;  nevertheless,  they  possess  especial  impor- 
tance from  their  association  with  other  notable  symptoms 
of  phosphorus-poisoning,  such  as  the  jaundice,  muscular 
pains  and  weakness,  diseased  condition  of  the  blood,  and 
albuminous  urine. 

The  contents  of  the  stomach  in  some  instances  evolve  the 
odor  and  fumes  ;  and  in  a  case  mentioned  by  Casper,  two 
days  after  death  luminous  vapors  issued  from  the  vagina, 
and  a  whitish  vapor  having  a  phosphorous  odor  issued  from 
the  anus.  In  this  instance  no  smell  or  vapor  of  phosphorus 
could  be  detected  on  opening  the  stomach  ;  nor  was  there 
any  part  of  its  lining  membrane  either  softened  or  corroded. 

Diagnosis.  —  Generally,  in  acute  cases,  there  will  be  no 
difficulty  in  recognizing  the  evidences  of  phosphorus-poi- 
soning, both  from  the  symptoms  and  post-mortem  lesions, 
as  above  detailed.     Chronic  cases  accompanied  by  jaundice 


440  TOXICOLOGY. 

might,  however,  be  mistaken  for  yellow  atrophy  of  the  liver. 
The  following  are  diagnostic  points  :  The  sensation  of  heat 
in  the  throat,  eructations  and  vomiting  of  matters  having 
a  garlicky  odor  and  a  luminous  appearance,  would  indicate 
phosphorus-poisoning.  The  icterode  appearance  is  not  so 
intense  in  the  poisoning  as  in  the  disease,  nor  is  it  accom- 
panied with  the  injection  of  the  eyes  or  with  the  fever 
which  mark  the  latter.  The  fatty  change  of  the  viscera 
may  be  seen  two  days  after  the  ingestion  of  the  poison. 
According  to  other  authorities,  the  liver  in  phosphorus- 
poisoning  is  enlarged,  dull  in  appearance,  doughy,  uniformly 
yellow,  with  the  acini  well  marked ;  in  acute  atrophy,  the 
liver  is  diminished  in  size,  greasy  on  the  surface,  of  a  dirty 
yellow  color,  and  the  acini  nearly  obliterated.  In  the 
former,  also,  the  hepatic  cells  are  either  filled  with  oil  glob- 
ules or  entirely  replaced  by  them  ;  in  the  latter  the  cells  are 
filled  with  a  fine  granular  detritus  and  thin  structure,  re- 
placed by  a  newly-formed  connective  tissue. 

Chemical  Analysis.  —  Phosphorus  is  a  white,  waxy  solid, 
nearly  twice  as  heavy  as  water,  readily  fusible  and  inflam- 
mable. It  evolves  fumes  at  ordinary  temperatures  when 
exposed  to  the  air,  and  appears  luminous  in  the  dark.  The 
smell  and  taste  of  phosphorus  recall  those  of  garlic,  by 
which  means  it  may  be  easily  recognized  when  mixed  with 
food  and  drinks.  The  fuming  of  phosphorus  in  the  air,  as 
also  its  luminosity,  is  completely  prevented  by  the  presence 
of  alcohol,  ether,  chloroform,  oil  of  turpentine,  and  other 
bodies,  even  in  minute  quantities.  Although  insoluble  in 
water,  phosphorus  ultimately  imparts  to  it  poisonous  prop- 
erties. It  is  tolerably  soluble  in  fixed  and  volatile  oils  by 
the  aid  of  heat ;  also  in  ether,  chloroform  and  naphtha  ; 
its  best'  solvent  is  carbon  disulphid.     Nitric  acid  converts 


PHOSPHORUS TOXICOLOGIC    EXAMINATION.  44 1 

it  into  phosphoric  acid.  It  is  not  affected  by  either  sul- 
phuric or  hydrochloric  acids.  It  is  preserved  under  water, 
to  protect  it  from  oxidation. 

In  its  free  state  phosphorus  is  easily  detected  by  its 
sensible  properties,  as  already  described.  A  fragment  put 
into  the  materials  for  generating  hydrogen  will  evolve 
hydrogen  phosphid,  easily  recognized  by  its  luminosity  in 
the  dark,  and  from  being  sometimes  spontaneously  inflam- 
mable. The  gas,  when  ignited  at  a  jet,  burns  with  a  green- 
ish-blue flame  ;  when  it  is  passed  through  a  solution  of 
silver  nitrate,  the  latter  is  blackened  by  the  production  of 
silver.  Phosphoric  acid  is  formed  in  the  solution,  and 
may  be  detected  by  the  appropriate  reagents. 

Toxicologic  Examination.  —  If  the  materials  evolve  whitish 
fumes,  which  are  luminous  in  the  dark,  and  have  an  allia- 
ceous odor,  there  can  be  no  doubt  of  the  presence  of  phos- 
phorus. If  the  mixture  be  ammoniacal,  from  putrefaction, 
sulphuric  acid  mu.st  first  be  added  until  the  liquid  is  slightly 
acid.  Sometimes  the  particles  of  phosphorus  may  be  sepa- 
rated mechanically  from  the  inside  of  the  stomach  and 
bowels,  which,  when  found,  should  be  carefully  washed  and 
set  aside.  Or  the  mass  may  be  spread  out  on  a  metallic 
plate  and  gently  heated  over  a  spirit-lamp,  when  the  minute 
fragments  of  phosphorus  will  take  fire  and  burn  with  a  bril- 
liant light.  The  suspected  particles  may  be  heated  under 
water,  when  they  will  melt  and  run  together  into  a  glo- 
bule, which  will  solidify  on  cooling,  and  may  easily  be 
identified. 

Carbon  disulphid  may  be  used  to  dissolve  out  the  phos- 
phorus from  many  organic  mixtures,  and  when  phosphorus- 
paste    has  been    employed.      On  allowing  the  solution  to 
evaporate  spontaneously,   the    phosphorus  will    remain    in 
37 


442  TOXICOLOGY. 

minute  globules,  which  can  readily  be  examined.  If,  how- 
ever, the  poison  is  in  solution,  or  in  too  minute  a  quantity 
for  the  above  tests,  it  must  be  examined  by  the  following 
processes  : 

Method  of  Mitscherlich.  —  The  suspected  liquid,  acidi- 
fied by  sulphuric  acid,  is  to  be  distilled  in  the  dark,  and  the 
vapors  conducted  through  a  long  glass  tube  kept  cold,  the 
end  of  which  passes  into  a  receiver.  On  gently  heating  the 
retort  or  flask,  the  vapors,  as  they  pass  through  the  cold 
tube,  condense  and  display  a  distinct  luminosity.  The 
phosphorus  thus  distilled  collects  with  the  aqueous  vapor 
in  the  receiver  to  which  it  imparts  the  usual  garlicky  odor. 
A  portion  of  it,  if  in  sufficient  quantity,  may  likewise  collect 
in  the  receiver  in  the  form  of  globules.  This  test  is  exceed- 
ingly delicate  and  satisfactory.  Taylor  states  that  the  head 
of  one  lucifer  match  produced  a  luminosity  which  continued 
for  half  an  hour  in  the  condensing  tube. 

The  presence  of  solid  phosphorus  in  the  distillate  would 
render  further  experiments  unnecessaiy ;  but  in  the  absence 
of  any  granules  the  distillate,  after  filtration,  should  be  acidi- 
fied by  nitric  acid,  which  will  convert  any  phosphorus  into 
phosphoric  acid ;  the  liquid  should  then  be  concentrated  by 
evaporation  and  tested.  If  no  luminosity  has  been  observed 
the  presence  of  a  small  amount  of  the  compounds  of  phos- 
phorus in  the  distillate  is  not  sufficient  to  warrant  the  suppo- 
sition of  poison,  since  these  might  have  been  derived  from 
the  food  or  tissues  and  carried  over  mechanically.  It  should 
be  remembered  that  it  is  only  free  phosphorus  that  gives  out 
the  luminosity  by  the  above  process  ;  the  distillation  of  the 
brain,  or  any  other  tissue  that  contains  this  substance  in 
combination,  never  produces  it. 


marsh's  test.  443 

Method  of  Lipowitz.  —  This  consists  in  boiling  the  sus- 
pected liquid,  slightly  acidulated  with  sulphuric  acid,  with 
fragments  of  sulphur,  in  an  apparatus  similar  to  that  em- 
ployed in  the  method  of  MitscherHch,  the  experiment  being 
conducted  in  the  dark.  The  sulphur  abstracts  the  phos- 
phorus from  even  complex  mixtures,  and  combines  with  it. 
The  boihng  is  continued  for  about  half  an  hour,  after  which 
the  pieces  of  sulphur  are  withdrawn  and  washed  in  water. 
They  will  now  emit  the  peculiar  odor  of  phosphorus,  and 
appear  luminous  in  the  dark.  On  gently  heating  them  with 
nitric  acid,  a  mixture  of  phosphoric  and  sulphuric  acids  will 
result.  By  evaporating  this  solution  to  near  dryness  to  get 
rid  of  the  sulphuric  acid,  then  diluting  and  filtering,  the 
phosphoric  acid  may  be  recognized  by  the  usual  tests.  In 
prosecuting  this  test,  unless  the  amount  of  phosphorus  is 
very  minute,  the  luminosity  of  the  vapor  may  also  be 
observed  in  the  cool  tube. 

Marsh.' S  Test. — This  process  is  based  upon  that  em- 
ployed in  testing  for  arsenic.  The  suspected  material, 
properly  prepared,  is  put  into  the  jar  containing  the  mate- 
rials for  generating  hydrogen  ;  the  resulting  gas  is  then 
passed  over  calcium  hydroxid,  for  the  purpose  of  removing 
any  hydrogen  sulphid  ;  it  is  then  ignited  at  the  end  of  the 
delivery  tube,  producing  a  green  flame.  The  phospho- 
retted  hydrogen  is  luminous  in  the  dark,  and  affords  a 
black  precipitate  with  silver  nitrate. 

Phosphorus  has  been  detected  in  the  free  state  as  late 
as  three  weeks  after  death  ;  but  it  is  very  apt  to  become 
oxidized  in  the  body,  in  which  case  it  can  only  be  identified 
as  phosphate. 

The  method  of  testing  for  phosphorus,  as  phosphates, 
in   a  case  of  suspected  poisoning  is   unsatisfactory,  since 


444  TOXICOLOGY. 

these  salts  always  exist  in  association  with  the  tissues  and 
secretions,  as  well  as  in  many  articles  of  food.  The  mode 
of  procedure  in  such  a  case  is  to  treat  the  mixture  with  a 
little  pure  nitric  acid,  and  concentrate  by  evaporation.  It 
is  then  treated  with  a  slight  excess  of  pure  sodium  carbon- 
ate and  evaporated  to  dryness,  and  fused  in  a  porcelain 
crucible.  The  resulting  sodium  phosphate  may  then  be 
tested  as  follows  : 

1.  Silver  nitrate  throws  down  yellow  silver  phosphate, 
soluble  in  ammonium  hydroxid  and  in  nitric  and  acetic 
acids.  Hydrochloric  acid  converts  it  into  the  white  chlorid. 
Silver  nitrate  also  gives  a  yellow  precipitate  of  silver  ar- 
senite  with  arsenites,  which  behaves  in  the  same  manner 
as  the  phosphate  ;  they  are  distinguished  by  drying,  and 
heating  in  a  reduction  tube  ;  silver  arsenite  yields  a  ring  of 
sublimed  octahedral  crystals. 

2.  Ammoninin  chlorid  and  magnesium  sidphate. — This 
mixture  gives  with  a  phosphate  a  characteristic  crystalline 
precipitate  of  ammonium  magnesium  phosphate  ;  the  mi- 
nutest quantity  can  be  identified  by  the  microscope. 

3.  Aninioniuni  Molybdate.  —  This  reagent  produces  a 
yellow,  pulverulent  precipitate  of  ammonium  phosphomolyb- 
date  ;  it  is  insoluble  in  the  strong  acids,  but  soluble  in  alka- 
line phosphates,  alkalies,  and  alkaline  carbonates. 

Red,    Amorphous,   or   Allotropic    Phosphorus.  —  This 

singular  variety  of  phosphorus  is  procured  by  exposing 
ordinary  phosphorus  to  a  heat  of  450°  F.  for  a  number  of 
hours  in  an  atmosphere  deprived  of  oxygen,  when  it  will 
change  to  a  brick-red  mass,  totally  unlike  the  ordinary  sub- 
stance, although  retaining  its  original  composition.  The 
difference  between  the  two  is  shown  by  reference  to  the  fol- 
lowing table  : 


lODIN SYMPTOMS; 


445 


Common  Phosphorus. 

Very  poisonous. 
Evolves  a  strong  odor. 
Phosphorescent. 
Melts  at  io8°  F. 
Transparent. 
Almost  colorless. 

Freely  soluble  in  some  liquids. 

Flexible. 

Oxidizes  in  the  air. 

Unites  readily  with  other  elements. 

Nitric  acid  acts   on   it  with  great 
energy. 


Red  PMosphorUS. 

Very  slightly  poisonous. 

Nearly  odorless. 

Not  phosphorescent. 

Melts  at  about  500°  F. 

Opaque. 

Varies  in  color  from  a  reddish- black  lo 
crimson. 

Nearly  insoluble  in  all  liquids. 

Brittle. 

Unalterable  in  the  air. 

Is  acted  on  by  other  elements  with  dif- 
ficulty. 

Nitric  acid  produces  no  effect. 


lODIN,  BROMIN,  AND  CHLORIN. 

lodin  occurs  in  shiny,  dark,  iron-gray  scales  ;  it  has  a 
peculiar  odor  and  disagreeable  taste  ;  when  heated  it  gives 
off  beautiful  violet-colored  fumes,  which  are  irritating  to 
the  nostrils  and  throat.  Sparingly  soluble  in  water,  very 
soluble  in  alcohol  and  ether,  and  also  in  the  aqueous  solu- 
tion of  potassium  iodid.  It  is  used  medicinally  in  the  form 
of  tincture,  compound  tincture,  and  ointment. 

Symptoms.  —  Like  phosphorus,  iodin  produces  a  local 
irritant  effect  and  a  remote  influence  ;  the  latter  the  result 
of  using  it  in  small  quantities.  In  large  doses  it  occasions 
burning  heat  in  the  throat ;  severe  pain  in  the  abdomen  ; 
vomiting  and  purging,  the  vomited  matters  having  the 
peculiar  odor  of  iodin,  sometimes  mixed  with  blood ;  the 
color  of  the  matters  is  yellowish,  except  when  they  consist 
of  farinaceous  articles,  in  which  case  it  is  blue.  The  bowels 
may  also  exhibit  the  presence  of  iodin.  Other  symptoms 
are  giddiness,  headache,  thirst,  anxiety,  convulsions,  and 
fainting-. 


44^  TOXICOLOGY. 

In  chronic  poisoning  (iodism)  the  symptoms  are  nausea, 
vomiting,  purging,  pain  of  stomach,  tremors,  palpitation, 
salivation,  cramps,  general  emaciation,  and  a  tendency  to 
absorption  of  certain  glands,  especially  the  testes  and  the 
mammae. 

There  is  a  remarkable  diversity  in  the  effects  of  iodin 
upon  the  human  system,  some  persons  bearing  very  large 
doses  with  little  or  no  suffering,  while  others  are  seriously 
affected  by  the  smallest  quantities.  Overdoses  have  occa- 
sionally proved  fatal,  leaving  morbid  appearances  very 
similar  to  those  produced  by  the  irritant  alkaline  salts. 

Chemical  Analysis.  —  In  its  free  state,  iodin  may  readily 
be  distinguished  by  its  solid  form,  color,  odor,  volatility, 
and  its  action  on  boiled  starch  —  quickly  turning  it  blue. 
When  in  combination  as  potassium  iodid,  the  iodin  must 
first  be  set  free  (by  chlorin  or  nitric  acid),  and  then  the 
starch-test  applied. 

From  organic  mixtures  the  iodin  may  be  separated  by 
like  use  of  carbon  disulphid  or  chloroform,  which  dissolve 
it ;  watery  liquid  should  be  separated  and  the  solvent  evap- 
orated at  a  very  low  temperature,  when  the  iodin  will  be  left. 

If  this  process  fails,  on  account  of  the  conversion  of  the 
iodin  into  hydriodic  acid  or  into  an  iodid,  it  will  be  advisable 
to  transmit  hydrogen  sulphid  through  the  mass,  properly 
diluted  ;  this  will  convert  any  free  iodin  into  hydriodic  acid  ; 
then  drive  off  the  excess  of  gas  by  heat,  add  potassium 
hydroxid  in  excess,  filter,  and  evaporate  to  dryness.  Char 
the  residue  at  a  low  red  heat,  to  get  rid  of  the  organic  mat- 
ter ;  pulverize  and  dissolve  in  water.  Concentrate  the 
solution,  and  add  strong  nitric  acid  and  boiled  starch,  which 
will  develop  the  iodin,  if  any  be  present. 

Potassium  Iodid. — Although  much  used  in  medicine,  in 


BROMIN.  447 

large  doses  it  occasionally  produces  violent  effects  upon  the 
system,  such  as  headache,  griping  abdominal  pains,  thirst, 
inflammation  of  the  nostrils  and  eyes,  and  frequent  pulse, 
together  with  salivation  and  a  pustular  eruption.  As  found 
in  the  shops,  it  is  apt  to  be  considerably  adulterated  with 
carbonate. 

Bromin.  —  This  is  a  dark-red,  volatile  liquid,  excessively 
pungent  to  the  eyes  and  respiratory  organs,  having  an  acrid 
odor  and  taste.  It  is  highly  corrosive,  destroying  animal 
tissues  very  rapidly.  It  has  occasionally  proved  fatally 
poisonous.  A  case  is  reported  by  Dr.  Sayre,  of  New  York, 
of  a  daguerreotyper  who  swallowed  an  ounce  of  bromin  for 
the  purpose  of  self-destruction.  The  immediate  symptoms 
were  spasmodic  action  of  the  muscles  of  the  larynx  and 
pharynx,  with  great  difficulty  of  breathing,  followed  by  in- 
tense burning  pain  in  the  stomach,  with  great  anxiety, 
restlessness,  and  trembling  of  the  hands.  The  pulse  was 
rapid,  tense,  and  corded,  and  respiration  greatly  hurried. 
Collapse  soon  followed,  and  death  took  place  in  seven  and 
a  half  hours  after  swallowing  the  poison. 

The  post-mortem  examination  revealed  vivid  injection  of 
the  external  coat  of  the  stomach  and  of  the  abdominal 
viscera  generally,  which  were  stained  of  a  deep  yellow  color. 
Portions  of  the  stomach  were  softened.  Its  contents  resem- 
bled port-wine  dregs,  and  exhaled  the  odor  of  bromin.  Its 
whole  interior  was  covered  with  a  thick,  black  layer,  resem- 
bling coarse  tanned  leather.  The  mucous  membrane  was 
very  thin  and  very  deeply  injected. 

Chemical  Analysis.  —  Bromin  may  be  separated  from 
organic  matters  by  means  of  carbon  disulphid  or  by  ether 
after  the  method  described  for  iodin.     The  bromids  may  be 


448  TOXICOLOGY. 

decomposed  by  chlorin  or  by  a  strong  acid.     Bromin  im- 
parts a  deep  yellow  color  to  boiled  starch. 

Chlorin  is  a  powerfully  irritating  gas,  of  a  greenish- 
yellow  color.  If  inhaled  it  may  destroy  life.  Chlorin  is 
readily  recognized  by  its  smell  and  color,  and  especially  by 
its  powerful  bleaching  properties. 

Chloi^iu  Oxids.  — The  following  instance  occurred  in  Ger- 
many. A  society  of  artists  had  for  some  time  been  using 
a  small  room  for  exposures  by  flashlight.  A  member  who 
entered  the  room  afterwards  was  found  therein  unconscious 
in  which  condition  he  remained  for  two  hours  after  removal 
to  his  home.  The  pulse  was  weak.  Consciousness  slowly 
returned  and  was  followed  by  persistent  vomiting.  There 
was  pain  in  the  back  of  the  head  and  in  the  temporal  region, 
with  numbness  in  the  forearms,  hands,  legs  and  feet.  Sight 
was  much  enfeebled.  The  pulse  was  for  some  time  not 
above  50  and  there  was  much  bronchial  catarrh.  After 
the  patient  had  perceptibly  improved,  a  careful  examination 
showed  marked  symmetrical  mydriasis  and  paralysis  of  the 
left  abducens  muscle.  Both  crystalline  lenses  were  turbid 
in  the  equatorial  region  with  intervening  light  and  dark 
stripes,  and  diffuse  turbidity  in  the  center.  The  patient  still 
complained  of  headache,  numbness  in  the  hands  and  formi- 
cation in  the  fingers.  A  marked  bronchial  catarrh  also  ex- 
isted with  a  pulse  of  100,  but  finally  the  normal  condition 
was  restored,  stimulants  and  protecting  spectacles  being 
employed. 

An  analysis  of  some  of  the  flashpowder  showed  that  it 
was  composed  of  equal  parts  of  powdered  magnesium  and 
potassium  chlorate,  and  probably  emitted  chlorin  oxids  in 
the  explosion. 


ARSENIC.  449 

ARSENIC. 

The  term  Arsenic,  as  employed  in  toxicology,  always 
signifies,  unless  specially  qualified,  arseiwus  oxid,  often, 
though  erroneously,  called  arsenous  acid.  The  element 
itself,  which  is  rarely  used  as  a  poison,  is  brittle,  of  a 
steel-gray  color,  volatile  when  heated,  its  vapor  having  a 
strong,  garlicky  odor,  by  which  it  may  be  recognized.  It 
is  sold,  however,  under  the  name  oi  fly  powder,  which  is  a 
mixture  of  the  metal  and  arsenous  oxid.  It  is  rather  an 
abundant  element,  and  occurs  in  a  number  of  minerals. 

Arsenic  is  one  of  the  most  important  of  all  the  poisons. 
The  facility  of  procuring  it  and  its  ease  of  administration 
contribute  greatly  to  its  extensive  use  both  as  a  homicidal 
and  suicidal  agent.  Under  the  name  of  "  Rough  on  Rats  " 
it  is  extensively  used  for  the  destruction  of  vermin. 

In  the  arts  arsenic  finds  many  uses,  as  in  the  manufacture 
of  enamel  and  glass,  composition  candles,  vermin-killers, 
dyes,  and  colors,  etc.  It  is  used  in  various  alloys,  as  spec- 
ulum metal,  white  copper,  and  shot ;  also  by  shipbuilders  to 
protect  timber  from  worms ;  farmers  use  large  amounts  of 
arsenical  compounds  for  destroying  plant  parasites.  One 
of  the  most  common  anilin  colors,  anilin  red,  fuchsin  or 
magenta,  is  sometimes  made  by  the  aid  of  arsenic  acid,  and 
hence  may  contain  notable  amounts  of  the  element.  The 
inhabtants  of  Styria  and  other  mountainous  countries  use 
arsenic  to  increase  their  powers  of  endurance.  Preparations 
containing  small  amounts  of  arsenic  are  sold  for  improving 
the  complexion.  Numerous  cases  of  slow  poisoning  by 
arsenic  occurred  in  1900  in  England.  The  symptoms  were 
principally  a  peripheral  neuritis,  and  were  traced  to  the 
presence  of  arsenic  in  brewing-sugars  which  had  been  made 
by  the  use  of  arsenical  sulphuric  acid. 
38 


450  TOXICOLOGY. 

Properties  of  Arsenoiis  Oxid. — It  occurs  in  commerce 
either  as  a  heavy  white  powder  or  in  masses,  which  are  at 
first  translucent  but  afterward  become  opaque.  It  is  nearly- 
tasteless.  It  is  slightly  soluble  in  cold  water,  and  there  is 
some  difference  between  the  solubihty  of  the  crystalhne  and 
of  the  opaque  varieties  ;  boiling  water  dissolves  it  more 
freely,  but  still  not  in  large  amount.  Its  solubility  is  much 
increased  by  the  addition  of  an  acid  or  an  alkali,  but  dimin- 
ished by  the  presence  of  organic  matter.  It  is  easily  held 
in  suspension  in  soups,  coffee,  tea,  or  milk. 

When  arsenous  oxid  is  heated  to  a  temperature  near 
400°  F.,  it  sublimes  in  the  form  of  a  white  vapor,  which 
is  inodorous,  and  is  deposited  on  a  cool  surface,  either  as 
an  amorphous  powder  or  in  octahedral  crystals.  If  thrown 
upon  red-hot  charcoal  it  is  decomposed,  and  the  vapoj;  will 
have  a  garlicky  odor. 

Symptoms.  —  The  rapidity  and  virulence  of  the  symptoms 
depend  somewhat  on  the  form  of  the  poison  {i.  e.,  whether 
in  solution  or  othenvise),  and  also  on  the  condition  of  the 
stomach.  As  a  rule,  the  symptoms  do  not  occur  for  half 
an  hour  or  an  hour.  There  is  first  a  sense  of  faintness 
attended  with  a  feeling  of  heat  and  constriction  of  the 
throat,  together  with  thirst,  nausea,  and  burning  pain  in  the 
stomach,  increased  by  pressure.  Vomiting  and  retching 
soon  follow  ;  the  matters  ejected  are  rarely  streaked  with 
blood  ;  they  may  be  variously  colored.  Purging  accom- 
panied with  tenesmus  comes  on,  and  along  with  the  vomit- 
ing may  be  incessant,  though  affording  no  relief  to  the 
sufferer.  Cramps  in  the  legs  are  apt  to  be  present,  along 
with  great  depression,  cold  sweat,  intense  thirst,  and  a  feeble, 
frequent  pulse.  The  whole  train  of  symptoms  may  re- 
semble a   severe  case  of  cholera   morbus,  for  which   it  has 


ARSENOUS    OXID SYMPTOMS.  45  I 

frequently  been  mistaken.  As  a  rule,  the  symptoms  are 
continuous,  although  there  are  occasionally  remissions  and 
even  intermissions.  Coma,  paralysis,  and  convulsions  may 
supervene  before  death.  The  urine  is  often  partially  sup- 
pressed. If  the  patient  recovers  from  the  immediate  at- 
tack, he  may  suffer  for  a  long  time  after  from  indigestion, 
partial  paralysis,  or  from  epilepsy. 

Certain  anomalies  may  occur.  The  pain  may  be  absent 
or  slight.  Occasionally,  there  is  a  remarkable  absence  of 
symptoms.  Vomiting  and  purging  and  thirst  may  not  be 
present.  Some  cases  especially  resemble  cholera  morbus 
from  the  intensity  of  the  gastro-enteric  irritability,  while 
others  indicate  severe  nervous  disturbance  by  the  intense 
headache,  giddiness,  restlessness,  violent  cramps,  delirium, 
convulsions,  and  coma.  Again,  there  may  be  immediate 
collapse,  little  or  no  pain,  vomiting,  or  purging,  but  a  cold, 
clammy  skin,  extreme  prostration,  very  frequent  and  feeble 
pulse,  slight  coma,  with  perhaps  convulsions  and  death 
within  a  few  hours  after  swallowing  the  poison.  In  a  few 
cases  the  symptoms  have  resembled  those  of  narcotics,  pro- 
found sleep,  deepening  into  coma,  and  death  in  a  few  hours 
without  rallying.  In  the  latter  cases  the  autopsy  may  show 
inflammation  of  the  stomach. 

The  symptoms  of  chronic  poisoning  usually  result  from 
small  doses  of  arsenic  frequently  repeated,  or  from  exposure 
to  the  vapors  of  arsenical  products,  as  in  the  case  of  work- 
men, or  from  the  accidental  inhalation  of  arsenical  dust 
from  wall  papers.  The  eyes  and  nasal  mucous  membrane 
become  inflamed  and  watery,  there  is  great  gastric  distress, 
with  frequent  sickness  and  vomiting,  diarrhea,  headache, 
and  giddiness,  a  jaundiced  skin,  an  eczematous  eruption, 
local  paralysis,  general  emaciation,  falling  out  of  the   hair, 


452  TOXICOLOGY. 

salivation  and  excoriation  of  the  tongue  with  hemorrhage;  and 
death  may  occur  from  exhaustion.  The  symptoms  in  such  a 
case  are  frequently  very  obscure  and  misleading,  and  perhaps 
chance  alone  may  reveal  the  real  source  of  the  disorder. 

The  time  when  the  symptoms  appear  varies  considerably. 
As  before  stated,  these  do  not  generally  manifest  themselves 
for  a  half  hour  or  an  hour  after  swallowing  the  poison  ;  but 
there  are  numerous  exceptions.  Cases  are  recorded  in 
which  it  is  claimed  they  appeared  in  the  act  of  swallowing, 
but  this  seems  incredible ;  others,  in  which  they  were  ex- 
hibited in  eight,  ten,  and  fifteen  minutes  after.  On  the 
other  hand,  numerous  instances  are  recorded  where  the 
time  was  protracted  for  many  hours.  A  case  has  been 
reported  in  which  the  symptoms  were  delayed  for  sixteen 
hours  after  a  dose  of  a  drachm  of  the  poison.  These  dis- 
crepancies may,  in  part,  be  accounted  for  by  the  stomach 
being  empty  or  full  at  the  time  of  administration  ;  also  by 
the  form  of  the  dose,  whether  hquid  or  solid ;  by  the  time 
of  day,  whether  before  going  to  sleep,  or  otherwise.  The 
simultaneous  use  of  opium  or  alcohol  would,  no  doubt, 
exercise  a  modifying  influence  over  this  poison. 

The  external  application  of  arsenic,  either  to  the  sound 
skin  or  still  more  to  abraded  or  ulcerated  surfaces,  is  often 
followed  by  fatal  results.  Proofs  of  this  are  exhibited  in 
the  effects  of  the  applications  of  cancer  cures  to  ulcerated 
breasts ;  also  in  the  use  of  arsenical  solutions  to  the  sore 
heads  of  children.  In  some  of  these  instances  absorbed 
arsenic  has  been  detected  after  death  in  the  viscera  of  the 
body.  Arsenic  has  also  proved  fatal  when  injected  into 
the  rectum  and  vagina. 

In  all  of  the  above  cases  of  the  external  application  of 
this  poison,  its  usual  constitutional  effects  were  produced, 


ARSENIC FATAL    PERIOD.  453 

such  as  burning  and  constriction  of  the  throat,  thirst,  vom- 
iting and  purging,  great  depression,  and  the  various  nervous 
disturbances  above  described. 

Fatal  Dose.  —  The  minimum  deadly  dose  cannot  be 
accurately  fixed.  The  usual  statement  that  two  grains 
may  be  fatal  rests  on  insufficient  evidence.  Dr.  Witthaus, 
in  a  thorough  search  of  reported  cases,  was  unable  to  find 
evidence  of  a  smaller  fatal  dose  than  thirty  grains,  but  the 
minimum  is  likely  to  be  below  this.  Probably  ten  grains 
would  be  fatal  to  most  persons  unless  treatment  was  prompt 
and  efficient.  Recoveries  have  occurred  after  very  large 
doses  but  usually  the  greater  part  has  been  expelled  by 
early  vomiting. 

Fatal  Period.  — The  great  majority  of  deaths  occur  within 
twenty-four  hours,  and  of  these  the  most  within  eight  or 
ten  hours.  The  shortest  period  is  recorded  by  Taylor,  of 
a  youth,  aged  seventeen  years,  who  died  in  twenty  minutes 
from  the  effects  of  a  large  dose  accidentally  swallowed ;  the 
symptoms  were  of  a  tetanic  character.  Other  cases  are 
reported  where  death  occurred  in  two  or  three  hours.  On 
the  other  hand,  life  may  be  prolonged  for  weeks,  months,  or 
even  years,  the  patient  suffering  greatly  during  the  interval. 

Arsenic  is  not  a  strongly  cumulative  poison  ;  it  is  tempo- 
rarily deposited  in  the  liver  and  other  organs  of  the  body, 
after  absorption,  but  it  is  rapidly  eliminated  from  the  system 
by  the  urine,  bile,  and  other  secretions.  Should  the  person 
survive  for  two  or  three  weeks,  no  trace  of  the  poison  may 
be  found  after  death,  in  consequence  of  its  total  elimination 
during  the  interim.  The  exact  period  at  which  arsenic  is 
completely  eliminated  from  the  human  system  is  not  fixed ; 
but  the  analyst  need  hardly  expect  to  discover  it  after  six- 
teen days,  although  it  has  been  detected  in  the  urine  of  a 


454  TOXICOLOGY. 

man  twenty -four  days  after  swallowing  a  large  dose,  and 
who  subsequently  recovered. 

The  rapidity  with  which  it  is  absorbed  and  deposited  in 
the  tissues  is  very  great.  Taylor  found  it  in  the  human 
liver  four  hours  after  it  had  been  swallowed,  though  doubt- 
less it  reaches  this  organ  much  sooner.  He  believes  that 
the  liver  acquires  its  maximum  of  absorbed  arsenic  (about 
two  grains)  in  fifteen  hours,  after  which  the  quantity  gradu- 
ally diminishes. 

The  question  of  the  elimination  of  arsenic  from  the 
human  system  may  have  an  important  bearing,  as  in  a  case 
in  which  a  person  who  has  been  taking  small  doses  of  arsenic, 
medicinally,  for  a  length  of  time,  should  suddenly  die  from 
gastro-enteritis,  and  a  post-mortem  examination  should 
reveal  the  presence  of  absorbed  arsenic  in  the  organs. 
Here  both  the  symptoms  and  the  chemical  analysis  would 
strongly  confirm  the  suspicion  of  arsenical  poisoning,  unless 
the  fact  of  the  medicinal  administration  of  the  drug  could 
be  satisfactorily  established. 

Post-mortem  Appearances.  —  The  most  decided  evidences 
of  the  irritant  character  of  the  poison  are  exhibited  by  the 
stomach,  the  mucous  lining  of  which  is  usually  highly 
inflamed,  sometimes  presenting  a  uniform,  deep-red  color, 
at  others  showing  patches  of  diffused  dark  redness.  Arsenic 
seems  to  have  a  specific  effect  on  the  stomach,  no  matter  by 
what  avenue  it  is  introduced  into  the  system.  Occasionally, 
the  lining  membrane  is  thickened  and  corrugated  ;  again,  it 
is  softened  and  readily  separated.  When  the  poison  has 
been  taken  in  substance,  it  is  not  unusual  to  find  patches 
several  inches  in  extent,  consisting  of  tough,  yellowish- 
white  masses  of  arsenous  oxid,  mixed  with  lymph  and  mucus, 
firmly  adherent  to  the  membrane,  and  forming  so  many  foci 


ARSENIC POST-MORTEM    APPEARANCES.  455 

of  intense  inflammation.  White  spots  of  arsenous  oxid  are 
often  found  between  the  rugae,  and  when  a  long  interval 
has  occurred  before  the  examination,  yellow  stains  may  be 
found,  as  the  result  of  a  decomposition  into  the  yellow 
sulphid. 

Ulceration  of  the  stomach  is  rare ;  but  Dr.  Reese  wit- 
nessed two  instances.  In  one,  death  occurred  in  eight  hours 
after  swallowing  the  poison.  In  the  other  case  the  exami- 
nation was  not  made  until  four  months  after  death  ;  here,  the 
ulcer  was  a  quarter  of  an  inch  in  diameter,  and  was  sur- 
rounded by  a  deep  zone  of  dark,  effused  blood,  and  had 
penetrated  down  to  the  peritoneal  coat  of  the  stomach. 
Perforation  has  not  been  reported. 

The  upper  portion  of  the  small  intestines  is  very  apt  to  be 
involved  in  the  inflammation  ;  also  the  cecum  and  rectum. 
Other  organs,  as  the  lungs,  brain,  and  bladder,  are  occasion- 
ally found  congested  ;  but  these  offer  no  diagnostic  points. 
The  most  remarkable  fact  connected  with  the  post-mortem 
appearances  is  the  occasional  absence  of  all  signs  of  inflam- 
mation, even  in  cases  where  there  had  been  violent  inflam- 
matory symptoms  before  death. 

When  death  occurs  within  a  few  hours  no  changes  in  the 
microscopic  appearance  of  the  tissues  may  be  recognizable, 
but  in  prolonged  cases  infiltration  and  fatty  degeneration  are 
likely  to  occur,  hence  careful  pathologic  examinations 
should  be  made  of  the  liver,  kidneys  and  heart. 

An  important  circumstance  is  the  antiseptic  power  of 
arsenic,  which  accounts  for  the  remarkable  preservation  of 
the  body  for  many  months  after  death,  whereby  the  detec- 
tion of  the  poison  is  possible  for  a  long  period  after  burial 
—  in  one  case  fourteen  years  after  death.  Of  course,  after 
such  an  interval  most  of  the  body  would  be  decomposed  ; 


456  TOXICOLOGY. 

but  still  enough  remains  for  the  purpose  of  identification. 
In  such  cases  there  is  generally  noticed  an  absence  of  the 
usual  cadaveric  odor,  and  also  the  presence  of  numerous 
yellow  patches  over  the  abdominal  viscera,  due  to  the  pro- 
duction of  the  yellow  sulphid,  by  the  action  of  hydrogen 
sulphid  on  the  arsenous  oxid. 

It  should,  however,  be  stated  that  arsenic  does  not  uni- 
formly exert  this  preservative  power  on  a  dead  body ;  in 
fact,  in  some  cases  it  would  seem  that  putrefaction  has  ad- 
vanced with  increased  rapidity.  These  instances,  however, 
are  exceptional ;  but  they  should  put  the  expert  on  his 
guard  against  too  positive  an  assertion  as  to  the  presence 
of  arsenic  when  a  body  exhibits  an  unusual  degree  of  pres- 
ervation, since  this  may  be  due  to  other  causes. 

Treatment.  —  Vomiting  should  be  promoted,  but  only  by 
the  mildest  means  ;  the  stomach-pump  may  be  employed, 
if  on  hand ;  warm  diluent  drinks  are  useful ;  after  this,  the 
free  use  of  freshly  prepared  ferric  hydroxid.  This  can  be 
prepared  extemporaneously  by  treating  a  solution  of  any 
red  salt  of  iron  with  any  alkali,  alkaline  carbonate,  or  mag- 
nesia. Ferric  chlorid  and  ferric  subsulphate  are  common 
compounds  suitable  for  the  purpose.  The  precipitate  should 
be  collected  on  a  strainer,  e.  g.,  a  piece  of  muslin  or  linen 
washed  two  or  three  times  with  water  and  administered 
freely,  best  in  milk  or  other  demulcent  liquid.  Afterward 
a  dose  of  castor  oil  should  be  given. 

There  are  numerous  attestations  to  the  value  of  this  anti- 
dote ;  it  acts  by  converting  the  poison  into  an  insoluble 
compound.  Freshly  precipitated  magnesium  hydroxid  is 
also  recommended  as  an  antidote. 

Ferrous  hydroxid  obtained  by  adding  an  alkali  to  a 
solution  of  ferrous  sulphate  (green  vitriol  or  copperas)  is 


ARSENIC ANALYTIC    METHODS.  457 

not  considered  an  antidote,  but  it  may  be  promptly  con- 
verted into  ferric  hydroxid  by  the  addition  of  some  hy- 
drogen dioxid.  The  change  is  indicated  by  the  conver- 
sion of  the  green  precipitate  into  a  red  one. 

Analytic  Methods.  Sublimation  Tests.  —  (i)  A  small 
quantity  of  the  white  powder  placed  on  platinum  foil  and 
heated  is  entirely  dissipated  in  white  inodorous  fumes  ;  (2) 
slowly  heated  in  a  narrow  glass  tube,  it  sublimes,  forming 
a  white  ring  of  octahedral  crystals  on  the  cool  portion  of 
the  tube  visible  by  a  good  magnifier.  Calomel  and  cor- 
rosive sublimate  will  each  form  white  rings  under  similar 
conditions  ;  the  arsenic  deposit  is  distinguished  from  these 
by  being  in  octahedral  crystals  ;  by  the  action  of  sodium 
hydroxid  solution  which  dissolves  it  without  color,  while 
it  gives  a  black  precipitate  with  calomel,  and  a  yellowish 
with  corrosive  sublimate  ;  (3)  moistened  with  ammonium 
sulphid,  and  evaporating,  it  produces  the  yellow  sulphid  ; 
(4)  put  into  a  reduction  tube,  along  with  some  reducing 
agent,  as  charcoal,  black  flux,  or  six  or  eight  times  its 
volume  of  dried  potassium  ferrocyanid,  and  heated  by  the 
flame  of  a  spirit-lamp,  it  is  reduced,  and  the  metal  is  vola- 
tilized, and  collects  on  the  cool  part  of  the  tube  in  the  form 
of  a  brilliant  steel-gray  ring,  or  mirror.  A  distinct  odor, 
recalling  that  of  garlic,  is  produced  in  this  form  of  the  test. 

In  order  to  effect  the  sublimation  and  reduction  success- 
full)^,  the  reduction  tube  should  be  small  —  about  the  eighth 
of  an  inch  in  diameter,  and  three  inches  long,  and  it  should 
be  clean  and  free  from  moisture.  The  reducing-  asfent 
should  be  dry  and  thoroughly  mixed  with  the  arsenous 
oxid.  After  it  is  introduced  the  tube  should  be  wiped  out 
with  a  wad  of  cotton  or  a  roll  of  filtering  paper.  The  tube 
should  first  be  gently  warmed  just  above  the  contents,  and. 


45  8  TOXICOLOGY. 

then  the  lower  portion  fully  heated  in  the  flame.  This 
precaution  insures  a  better  formed  metallic  ring. 

For  the  sublimation  simply,  the  above  process  is  to  be 
pursued,  with  the  omission  of  the  reducing  agent. 

The  obtaining  the  metallic  ring,  or  mirror,  by  the  reducing 
process,  may  be  regarded  as  positive  proof  of  the  presence 
of  arsenic ;  but  in  a  medico-legal  case  this  should  be  con- 
firmed by  further  proofs  :  (i)  the  arsenic  mirror  is  wholly 
soluble  in  sodium  hypochlorite  ;  (2)  it  is  soluble  in  hot 
nitric  acid,  and  the  solution,  on  evaporation,  leaves  a  brick- 
red  deposit  when  touched  with  silver  nitrate  solution,  due 
to  the  formation  of  silver  arsenite ;  (3)  if  the  closed  end  of 
the  tube  be  broken  off  and  heat  applied  to  the  sublimate,  it 
will  readily  volatilize,  and,  combining  with  the  oxygen  of 
the  air,  will  condense  on  the  upper  portion  of  the  tube  in  a 
white  ring  of  arsenous  oxid  ;  (4)  this  latter  may  be  dissolved 
in  a  few  drops  of  warm  water  and  subjected  to  the  liquid 
tests. 

The  Liquid  Tests.  —  These  are  ammonio-copper  sulphate 
and  ammonio-silver  nitrate.  They  should  be  prepared  only 
when  required  for  use.  The  former  is  made  by  the  cautious 
addition  of  ammonium  hydroxid  to  a  somewhat  dilute  solu- 
tion of  copper  sulphate,  until  the  precipitate  is  barely  redis- 
solved.  When  this  reagent  is  added  to  a  solution  of  arsen- 
ous oxid,  it  throws  down  light-green  copper  arsenite.  This 
precipitate  is  soluble  in  ammonium  hydroxid  and  in  free 
acids.  If  the  arsenic  is  in  very  minute  quantities,  the  char- 
acteristic color  does  not  appear  immediately,  but  is  depos- 
ited on  standing. 

The  silver  test  is  prepared  by  adding  ammonium  hydroxid 
to  a  strong  solution  of  silver  nitrate,  until  the  precipitate  is 
barely  redissolved.     When  this  is   added  to  the  arsenical 


ARSENIC FALLACIES.  459 

solution,  a  canary-yellow  precipitate  of  silver  arsenite  occurs, 
which  is  freely  soluble  in  alkalies  and  acids. 

These  liquid  tests  are  available  only  in  perfectly  pure 
solutions  of  arsenous  oxid ;  they  are  inadmissible  in  the 
presence  of  organic  matter,  since  various  organic  substances 
will  produce  similar  colors.  They  may,  however,  be  satis- 
factorily confirmed,  (i)  by  heating  either  of  the  dried  pre- 
cipitates (copper  or  silver  arsenites),  either  alone  or  with  a 
reducing  agent,  in  a  reduction  tube  ;  the  former  experiment 
will  yield  a  sublimate  of  octahedral  crystals,  the  latter  the 
metallic  mirror.  (2)  If  the  solution  of  copper  arsenite  in 
ammonium  hydroxid  be  poured  over  a  crystal  of  silver 
nitrate,  a  film  of  yellow  silver  arsenite  is  immediately 
formed  around  it. 

The  Hydrogen  Sulphid  Test.  —  This  consists  in  passing 
washed  hydrogen  sulphid  gas  through  the  solution,  slightly 
acidified  by  hydrochloric  acid  ;  a  clear  yellow  precipitate 
falls  —  arsenous  sulphid,  soluble  in  the  alkalies  and  insolu- 
ble in  acids.  In  very  dilute  solutions,  the  precipitate  may 
not  separate  until  the  excess  of  the  gas  is  driven  off  by 
heat. 

Fallacies.  —  Cadmium,  tin,  and  selenium  yield  somewhat 
similar  precipitates.  Practically,  the  only  one  that  need  be 
considered  is  cadmium,  which,  however,  is  easily  distin- 
guished, as  follows  :  (i)  The  arsenous  sulphid  is  soluble  in 
ammonium  hydroxid  and  insoluble  in  the  acids  ;  with  cad- 
mium sulphid  it  is  precisely  the  reverse  ;  (2)  when  dried 
and  sublimed  with  a  reducing  agent,  the  arsenous  sulphid 
yields  a  metallic  ring  ;  the  cadmium  a  brown  oxid. 

The  arsenous  sulphid  may  be  proved  by  (i)  obtaining  the 
metallic  ring  by  subliming  with  a  reducing  agent ;  (2)  by 
boiling  the  sulphid  in  hydrochloric  acid,  along  with  a  piece 


460  TOXICOLOGY. 

of  bright  copper  foil ;  a  steel-gray  deposit  shows  the  pres- 
ence of  arsenic  ;  (3)  by  dissolving  it  in  boiling  nitric  acid, 
cautiously  evaporating  to  dryness,  and  adding  a  few  drops 
of  strong  silver  nitrate  solution,  a  brick-red  silver  arsenate 
will  be  produced. 

Marsh's  Test. — The  principle  here  involved  is  that 
when  arsenic  comes  in  contact  with  nascent  hydrogen,  it 
combines  with  it  to  form  hydrogen  arsenid  (arsin),  a  gas 
which  possesses  peculiar  properties,  by  means  of  which  the 
arsenic  may  be  recognized  with  great  certainty.  The  sim- 
plest method  is  to  add  to  the  materials  for  generating  hy- 
drogen (zinc,  water,  and  sulphuric  acid),  in  a  wide-mouth 
flask,  the  suspected  arsenical  solution.  The  cork  fitted  to 
the  mouth  of  the  flask  should  have  two  perforations,  through 
one  of  which  a  perpendicular,  funnel-shaped  glass  tube 
passes  down  below  the  surface  of  the  liquid  contents  ; 
through  the  other  aperture  a  tube,  bent  at  right  angles,  is 
inserted,  out  of  which  the  generated  gas  issues.  A  drying 
tube  (containing  fragments  of  fused  calcium  chlorid,  or 
of  pumice  stone  moistened  with  sulphuric  acid)  is  fastened 
by  one  end  to  the  exit-tube,  and  by  the  other  extremity 
to  a  horizonal  tube  of  hard  German  glass,  about  a  foot 
long,  which  may  be  turned  up  at  the  furthest  end,  and  made 
to  terminate  in  a  small  point,  for  burning  the  gas  in  a  jet  as 
it  escapes. 

In  performing  this  experiment  certain  precautions  are 
necessary.  In  the  first  place,  the  absolute  purity  of  the 
zinc  and  sulphuric  acid  must  be  secured.  The  acid  should 
be  diluted  with  two  or  three  times  its  volume  of  water 
before  being  added  to  the  zinc  mixture.  Secondly,  caution 
should  be  exercised  to  have  the  atmospheric  air  completely 
expelled  from  the  apparatus  before  lighting  the  jet,  other- 


ARSENIC marsh's    TEST.  46 1 

wise  the  mixture  of  hydrogen  and  air  will  produce  a  violent 
explosion.  The  evolution  of  the  hydrogen  should  be 
rather  slow.  After  waiting  the  proper  time,  the  jet  may  be 
lighted  ;  it  will  burn,  if  pure,  with  a  nearly  colorless  flamet 
though  it  is  usually  yellowish  from  the  sodium  of  the  glass 
point.  The  purity  of  the  materials  may  now  be  tested  by 
applying  the  flame  of  a  large  spirit-lamp  or  a  Bunsen 
burner  to  the  horizontal  glass  tube  until  it  is  red-hot ;  if  no 
stain  or  deposit  occurs  just  beyond  the  heated  spot,  the 
absence  of  arsenic  is  certain  ;  or  if  no  deposit  forms  on  a 
piece  of  white  porcelain  held  over  the  burning  jet,  the  same 
conclusion  may  be  held. 

A  small  quantity  of  the  suspected  solution  is  now  to  be 
introduced  through  the  upright  tube;  action  immediately 
commences,  producing  hydrogen  arsenid,  which  has  the 
following  characteristic  properties  : 

As  soon  as  the  arsenic  combines  with  the  hydrogen,  an 
immediate  change  occurs  in  the  appearance  of  the  flame, 
which  increases  in  size  and  acquires  a  faint  bluish  color  ; 
and  unless  the  arsenic  be  in  minute  quantity  it  evolves 
white  fumes  and  gives  out  a  garlicky  odor.  If  these  fumes 
are  received  into  a  short,  wide  glass  tube,  they  will  con- 
dense into  a  white  powder,  sometimes  crystalline,  and  may 
be  identified  as  arsenous  oxid. 

If  the  jet  be  made  to  impinge  on  a  piece  of  glass  or 
white  porcelain,  held  horizontally  and  just  within  the 
flame,  a  deposit  of  pure  arsenic,  of  a  brilliant  steel-gray,  or 
brownish-gray  color,  occurs,  which  may  be  multiplied  by 
changing  the  position  of  the  porcelain.  In  order  to  procure 
the  finest  deposits  the  flame  should  be  steady  and  not  too 
large.  Although  these  spots  may  vary  somewhat  in  color, 
they  are  always  brilliant  and  never  sooty. 


462  TOXICOLOGY. 

These  deposits  may  be  identified  (i)  by  their  immediate 
solubihty  in  sodium  hypochlorite ;  stains  of  antimony, 
which  they  most  resemble,  are  not  thus  affected.  (2)  When 
touched  by  a  drop  of  ammonium  sulphid,  they  do  not 
immediately  disappear ;  antimony  stains  are  instantly  dis- 
solved. (3)  Both  stains  are  attacked  by  hot  nitric  acid,  and 
on  evaporation  yield  white  residues  ;  if  now  touched  with  a 
drop  of  strong  solution  of  silver  nitrate,  the  arsenic  spot 
assumes  a  brick-red  color,  while  the  antimony  stain  remains 
unaffected. 

On  placing  the  flame  of  a  large  spirit-lamp  or  a  Bunsen 
burner  immediately  below  the  horizontal  tube  (which  should 
have  been  previously  contracted  in  several  places),  a  deposit 
of  metallic  arsenic  forms  just  in  advance  of  the  flame,  which 
should  be  held  a  little  behind  one  of  the  contracted  spaces ; 
the  deposit  continues  to  increase  until  it  may  completely 
occupy  the  whole  of  the  narrow  space,  and  even  advance 
beyond  it.  This  constitutes  the  arsenical  mirror.  It  may 
have  the  steel-gray,  brilliant  appearance  already  described, 
or  even  a  coppery  hue,  and  it  is  highly  characteristic  of  the 
presence  of  arsenic.  Several  such  mirrors  may  thus  be  ob- 
tained by  moving  the  flame  to  different  parts  of  the  hori- 
zontal tube,  provided  there  is  a  sufficient  amount  of  the 
material  present.  The  tube  may  afterward  be  broken 
across,  so  as  to  separate  the  mirrors,  which  may  be  retained 

for  exhibition  or  for  other  tests. 

.* 

This  mode  of  experimenting  yields  even  more  delicate 
results  than  the  jet ;  but  unless  the  quantity  of  arsenic  is 
extremely  small,  it  will  always  be  possible  to  obtain  both 
results  by  Marsh's  process. 

One  fallacy  only  may  interfere  with  this  experiment  — 
the  presence  of  antimony,  which  in  contact  with  hydrogen 


ARSENIC REINSCH's     TEST.  463 

yields  a  gas  very  similar  to  hydrogen  arsenid,  and,  like 
the  latter,  is  decomposed  by  heat,  yielding  a  metallic  de- 
posit. They  may  be  distinguished  as  follows  :  The  anti- 
mony mirror  is  deposited  just  over  the  heated  spot  and  not 
in  advance  of  it ;  it  has  usually  a  darker  appearance  than 
the  arsenical  mirror  ;  the  latter  is  more  easily  volatilized 
than  the  former  and  condenses  higher  up  in  the  tube  in 
octahedral  crystals.  The  two  deposits  may  also  be  tested 
by  the  different  reagents  mentioned  above  ;  also  by  dry 
hydrogen  sulphid,  which  produces,  with  the  arsenical  gas, 
a  yellow  deposit,  and  with  the  antimonial  gas  an  orange-red. 

If  the  hydrogen  arsenid  be  passed  through  a  solution 
of  silver  nitrate,  a  black  precipitate  of  metallic  silver  is 
formed,  arsenous  oxid  remaining  in  the  solution.  The 
filtered  solution  will  contain,  also,  free  nitric  acid  and  any 
excess  of  silver  nitrate.  On  neutralizing  with  ammonium 
hydroxid  a  yellow  precipitate  will  fall  —  silver  arsenite. 
The  analyst  should  not  rely  on  the  mere  production  of  the 
black  color,  since  other  gases  beside  hydrogen  arsenid 
might  cause  this  ;  but  he  should  continue  the  experiment 
as  above  described. 

Bloxam's  Method.  —  The  principle  of  this  is  the  same  as 
that  in  Marsh's  process  — the  action  on  nascent  hydrogen  ; 
but  an  electric  current  is  employed  to  decompose  the  water 
instead  of  zinc.  It  is  a  delicate  and  satisfactory  modifica- 
tion ;  but  it  should  be  remembered  that  the  arsenic  should 
be  present  in  the  form  of  arsenous  oxid. 

Reinsch's  Test.  — This  consists  in  producing  a  deposit 
of  copper  arsenid  on  bright  copper  foil.  The  suspected 
solution,  acidulated  with  about  one  sixth  of  its  bulk  of 
pure  hydrochloric  acid,  is  first  brought  to  the  boiling-point. 


464  TOXICOLOGY. 

and  a  piece  of  bright  copper  foil  is  introduced  and  the 
boihng  continued.  The  presence  of  even  a  very  minute 
quanity  of  arsenic  is  soon  indicated  by  the  tarnishing  of 
the  copper,  which  ultimately  assumes  a  dark  steel-gray  or 
even  black  color.  If  the  quantity  of  arsenic  be  large,  the 
deposit  is  immediate  and  veiy  dark  ;  it  may  even  break  off 
in  scales  ;  if  the  amount  is  very  small,  the  stain  upon  the 
copper  will  be  fainter  and  merely  of  a  violet  or  bluish  tint. 
Moreover  the  deposit  on  the  copper  is  affected  by  the 
degree  of  dilution  ;  hence,  if  the  quantity  of  the  water  be 
large,  it  should  be  reduced  by  evaporation,  as  it  may  re- 
quire boiling  for  half  an  hour  before  a  visible  deposit  occurs. 

This  reaction  is  very  delicate  and  extremely  satisfactory, 
and  commends  itself  by  its  simplicity.  One  great  advan- 
tage that  it  possesses  over  the  other  tests  is  that  it  may  be 
practiced  in  complex  organic  fluids  ;  hence,  it  is  often  em- 
ployed as  a  trial  test. 

Certain  precautions  are,  however,  required  in  employing 
it.  First,  the  purity  of  the  hydrochloric  acid  must  be  in- 
sured ;  this  is  easily  accomplished  by  first  boiling  some  of 
the  acid  diluted  with  water  and  then  introducing  a  slip  of 
the  copper.  If  no  stain  appears  upon  the  latter  after  a  few 
minutes,  we  may  be  certain  of  the  absence  of  arsenic  or 
antimony.  Secondly,  the  copper  must  be  both  bright  and 
pure.  Its  brightness  is  effected  by  rubbing  it  with  emery 
paper,  and  it  may  be  regarded  as  pure  if,  when  boiled  in 
the  acid  arsenical  liquid,  it  is  not  dissolved  and  does  not 
impart  a  green  color  to  the  liquid.  Copper  and  pure  hydro- 
chloric acid  adapted  to  use  in  these  tests  can  now  be 
easily  obtained  from  dealers. 

In  applying  this  test  it  is  best  to  use  small  pieces  of 
copper  successively,  removing  each  fragment  as  it  becomes 


ARSENIC REINSCH's    TEST.  4^5 

coated.  By  this  means  the  whole  of  the  arsenic  may  be 
removed  from  the  solution.  One  grain  of  arsenous  oxid 
dissolved  in  the  acid  solution  and  treated  by  Reinsch's 
process  will  impart  a  distinct,  dark,  steel-gray  coating  to  at 
least  four  hundred  square  inches  of  copper  surface.  This 
method  will,  therefore,  serve  for  an  approximative  quanti- 
tative estimate  of  the  poison.  When  it  is  in  the  form  of 
arsenic  acid,  the  solution  is  required  to  be  much  stronger 
for  this  test. 

Another  caution  to  be  observed  is  not  to  remove  the 
copper  too  soon  from  the  liquid,  in  case  no  deposit  occurs  ; 
in  doubtful  cases,  the  boiling  should  be  continued  for  at 
least  ten  minutes.  If  the  copper  be  kept  in  for  an 
hour  or  longer  it  may  acquire  a  dark  film,  especially  in 
the  presence  of  organic  matter,  even  in  the  absence  of 
arsenic. 

Fallacies. — Other  substances — antimony,  mercury,  silver, 
bismuth,  tin,  gold,  platinum,  and  palladium ;  likewise  organic 
matter,  especially  if  it  contain  sulphur  —  will  impart  a  dark 
coating  to  copper  in  Reinsch's  process ;  hence,  corrobora- 
tive proof  is  required.  This  is  afforded  by  washing  a  frag- 
ment or  two  of  the  coated  copper  in  distilled  water,  and 
then  thoroughly  drying  them  between  the  folds  of  filtering 
paper  (avoiding  touching  with  soiled  fingers),  and  rolling 
them  up  into  small  coils,  and  then  introducing  one  or  more 
of  them  into  a  small,  clean  reduction  tube,  and  applying  the 
heat  of  a  spirit-lamp.  The  arsenic  will  volatilize  and  con- 
dense in  the  cool  part  of  the  tube,  in  a  white  ring  of  octa- 
hedral crystals.  The  only  other  metals  which  could  vola- 
tilize under  such  circumstances  are  antimony  and  mercury ; 
but  the  sublimate  from  antimony  is  either  amorphous,  or 
else  in  fine,  acicular  ciystals,  while  the  mercurial  deposit 

39 


466 


TOXICOLOGY. 


consists    of   fine,  spherical    globules  of   the    metal,  easily- 
recognized  by  a  magnifier. 

The  attention  of  the  toxicologist  should  especially  be 
directed  to  the  fact  that  if  copper  be  boiled  for  some  time 
m  an  acid  solution  of  complex  organic  matters,  especially 
containing  sulphur,  it  will  become  coated  with  a  decided 
dark  stain,  and  will,  moreover,  yield,  when  heated  in  a  reduc- 
tion tube,  an  amorphous  sublimate,  which  may  even  some- 
times show  acicular  crystals,  consisting  apparently  of  a 
compound  of  copper.  This  sublimate  deposits  very  near 
the  copper,  and  will  not  re-sublimate.  Hence,  it  follows  that, 
for  the  complete  corroboration  of  Reinsch's  test  for  arsenic, 
nothing  short  of  the  production  of  the  octahedral  crystals 
and  their  subsequent  identification  will  suffice.  Wormley 
has  observed  that  an  antimonial  deposit  from  the  copper 
may  occasionally  contain  octahedral  crystals,  which  are 
found  lower  down  in  the  deposit. 

It  must  also  be  remembered  that  the  presence  of  certain 
substances  in  the  arsenical  solution  may  prevent  the  deposit 
of  this  metal  upon  the  copper  —  viz.,  a  chlorate  or  other 
oxidizing  agents.  Consequently,  Reinsch's  test  is  not  .ap- 
plicable to  a  solution  obtained  by  boiling  viscera  in  hydro- 
chloric acid  and  potassium  chlorate. 

Bettendorf's  Test.  —  A  saturated  solution  of  stannous 
chlorid  in  concentrated  hydrochloric  acid  produces  with 
arsenical  compounds  a  brownish  or  grayish  precipitate  of 
free  arsenic.  The  introduction  of  a  small  piece  of  tin  foil  is 
an  advantage  in  some  cases,  but  this  must  not  be  done  when 
bismuth,  antimony,  or  other  easily  reducible  substance  is 
present.  The  application  of  a  moderate  heat  is  advisible. 
Toxicologic  Examination. — The  analyst  should  always 
first  search  for  particles  of  solid  arsenous  gxid  in  the  stomach 


ARSENIC STOMACH    AND    CONTENTS.  46/ 

and  the  vomited  matter,  and  carefully  remove  these  for 
examination.  Organic  mixtures  should  be  diluted,  if  neces- 
saiy,  with  distilled  water,  and  acidified  with  about  one  sixth 
part  of  hydrochloric  acid,  and  boiled  gently  for  about  fif- 
teen minutes  ;  when  cooled,  the  mixture  should  be  strained 
and  concentrated  by  evaporation  over  a  water-bath.  A 
portion  may  now  be  subjected  to  a  trial  test  by  Reinsch's 
process  ;  if  no  deposit  takes  place  after  boihng  for  half  an 
hour,  it  is  safe  to  conclude  that  no  arsenic  is  present.  If 
deemed  advisable,  another  portion  of  the  filtrate  may  be 
subjected  to  the  action  of  hydrogen  sulphid.  It  is  not 
yet  fitted  for  Marsh's  process,  owing  to  the  large  amount 
of  organic  matter  present,  which  causes  much  frothing. 

Stomach  and  Contents.  —  The  organ  should  first  be 
carefully  examined  as  to  its  pathologic  condition,  and  also 
for  the  presence  of  solid  particles  of  the  poison.  It  should 
then  be  cut  up  into  small  fragments  with  scissors  known  to 
be  perfectly  clean,  and,  together  with  its  contents,  placed 
in  a  clean  porcelain  evaporating  dish  ;  distilled  water  added 
in  sufficient  quantity,  together  with  about  one  sixth  the 
bulk  of  pure  hydrochloric  acid,  and  heated  gently  for  about 
an  hour,  when  most  of  the  solid  portions  will  have  become 
disintegrated.  After  cooling,  the  mixture  is  thrown  upon 
a  muslin  strainer  and  the  solid  matters  washed  several 
times  with  pure  warm  water  and  squeezed.  The  strainer 
and  contents  should  be  preserved  for  subsequent  examina- 
tion. The  filtrate  should  be  concentrated  by  evaporation 
over  a  water-bath  and  then  filtered  through  paper. 

Reinsch's  process  may  now  be  applied  as  a  trial  test  to 
a  portion  of  the  liquid.  If  no  result  is  afforded  after  a 
sufficient  boiling,  another  portion  may  be  tried  by  hydrogen 


4^8  TOXICOLOGY. 

sulphid ;  and  if  these  give  negative  results,  the  absence  of 
arsenic  may  be  regarded  as  established.  Marsh's  process 
is  inadmissible  here  for  the  reason  just  stated. 

If  the  presence  of  the  poison  is  revealed  by  the  trial 
test,  a  given  portion  of  the  hquid  may  be  completely  ex- 
hausted by  Reinsch's  process  and  the  balance  treated  with 
hydrogen  sulphid  for  several  hours,  until  all  the  arsenic  is 
precipitated.  This  process  is  facilitated  by  gently  warming 
the  liquid.  The  resulting  precipitate  will  have  a  dirty 
yellowish  color,  —  not  the  bright  yellow  seen  when  the 
arsenous  oxid  is  pure,  —  and  will  contain  both  organic 
matter  and  reduced  sulphur  in  greater  or  less  amounts. 

The  mere  production  of  such  a  precipitate  is  not  suffi- 
cient of  itself  to  establish  the  presence  of  arsenic,  since  it 
is  known  that  in  an  acid,  complex,  organic  solution,  asso- 
ciated with  coloring  matter,  hydrogen  sulphid  will  throw 
down  a  precipitate  very  much  resembling  an  impure  arsen- 
ous or  antimony  sulphid,  but  consisting  only  of  organic 
matter  and  free  sulphur ;  hence,  a  further  examination  is 
required  to  verify  this  suspected  sulphid. 

The  precipitate  should  be  washed  carefully  on  a  filter 
and  digested  with  pure  ammonium  hydroxid,  which  will 
dissolve  out  all  the  arsenous  sulphid  together  with  some 
organic  matter.  The  solution  is  filtered  and  carefully 
evaporated  to  dryness.  If  much  arsenous  sulphid  is  pres- 
ent it  will  have  a  decided  yellow  color.  When  perfectly 
dried  it  should  be  verified  by  the  methods  described  above. 
If,  however,  only  a  minute  quantity  be  present,  the  dried 
residue  will  have  a  brown  color  and  must  be  purified  as 
follows :  It  is  placed  in  a  porcelain  capsule,  a  little  concen- 
trated nitric  acid  added,  and  the  mixture  evaporated  to 
dryness  over  a  water-bath,  the  addition  of  acid  being  re- 


SEPARATION    OF    ARSENIC    FROM    THE   TISSUES.  469 

peated  until  the  moist  residue  has  a  yellow  color.  It  is 
next  moistened  with  a  few  drops  of  solution  of  sodium 
hydroxid,  together  with  a  little  pure  sodium  carbonate  and 
sodium  nitrate,  well  stirred,  and  cautiously  evaporated  to 
diyness.  The  heat  is  now  gradually  increased  until  the 
mass  becomes  colorless,  when  the  organic  matter  may  be 
considered  completely  destroyed.  The  cooled  mass  con- 
sists of  a  mixture  of  the  sodium  arsenate  with  sodium 
nitrate  and  nitrite.  It  should  be  dissolved  in  warm  water, 
and  after  filtration  should  be  acidulated  with  pure  sulphuric 
acid  and  evaporated  till  dense  white  fumes  appear.  By 
this  treatment  the  residue  is  reduced  to  a  mixture  of  the 
sodium  arsenate  and  sodium  sulphate.  A  portion  of  this 
solution  may  now  be  tested  in  a  Marsh  apparatus  ;  another 
given  portion  by  hydrogen  sulphid  for  quantitative  deter- 
mination, the  arsenic  acid  being  first  reduced  to  arsenous 
by  sulphurous  acid  or  sodium  sulphite. 

Separation  of  Absorbed  Arsenic  from  the  Tissues. — 

It  is  indispensable  in  such  investigations  to  examine  for 
absorbed  arsenic  in  the  different  viscera,  as  the  liver,  kid- 
neys, spleen,  etc.,  inasmuch  as  its  detection  in  the  organs 
is  evidence  that  the  poison  had  been  actually  taken  during 
life,  provided  always  that  post-mortem  imbibition  can  be 
excluded.  Besides,  it  may  happen  that,  if  the  quantity 
swallowed  has  been  only  just  sufficient  to  have  caused 
death,  the  whole  of  it  may  have  disappeared  from  the 
stomach  by  absorption  and  can  only  be  discovered  in  the 
organs.     The  brain  should  likewise  always  be  examined. 

Several  methods  are  described  for  this  sort  of  research, 
all  having  reference  to  one  common  end  —  the  destruction 
of  organic  matters.     Very  often  satisfactory  results  can  be 


470  TOXICOLOGY. 

obtained  by  simply  boiling  the  finely  divided  tissue  in  water 
and  hydrochloric  acid  and  applying  Reinsch's  test. 

Method  of  Fresenius  and  Babo. — The  solid  matters 
(as  about  one  fourth  of  the  liver)  should  be  finely  divided, 
pressed  in  a  mortar,  and  pure  water  added  to  bring  it  to 
the  consistence  of  thin  gruel.  The  whole  should  then  be 
digested  in  a  porcelain  dish  over  a  water-bath  with  pure 
hydrochloric  acid  about  equal  in  weight  to  the  diy  material. 
Small  quantities  of  powdered  potassium  chlorate  are  from 
time  to  time  added  to  the  hot  liquid,  when  effervescence 
will  occur  with  escape  of  chlorin  gas.  In  a  short  time  the 
solid  matters  will  disappear  and  the  liquid  will  acquire  a 
clear  yellow  color.  The  heat  should  be  continued  until 
all  odor  of  chlorin  has  disappeared.  When  the  liquid  has 
cooled  it  should  be  properly  strained.  Any  arsenic  present 
will  now  exist  in  the  form  of  arsenic  acid. 

A  portion  of  this  liquid  may  be  tested  in  a  Marsh  appa- 
ratus. But  for  the  other  tests  it  is  necessary  that  the  arsenic 
acid  should  be  reduced  to  the  lower  oxid  —  arsenous.  This 
is  effected  by  adding  sodium  sulphite  to  the  solution  and 
heating  it  until  all  odor  of  sulphurous  acid  has  disappeared. 
It  is  now  allowed  to  stand  for  several  hours  and  any  deposit 
removed  by  filtration.  The  resulting  solution,  after  proper 
evaporation  over  a  warm  bath,  may  be  examined  by  hydro- 
gen sulphid,  but  not  by  Reinsch's  process,  for  the  reason 
above  given. 

Method  of  Danger  and  Flandin.  —  The  organs,  prop- 
erly divided,  are  introduced  into  a  glass  retort,  together 
with  one  fourth  their  weight  of  strong  sulphuric  acid,  and 
heated  on  a  sand-bath  until  the  whole  is  thoroughly  car- 


DlSTlLLATiON    PROCESS.  4/1 

bonized  and  dried.  After  cooling,  the  mass  is  removed  and 
powdered.  The  powder  is  moistened  in  a  porcelain  capsule, 
with  one  tenth  of  its  weight  of  pure  nitric  acid,  and  heated 
on  a  water-bath  for  half  an  hour.  This  converts  the  arsenic 
into  arsenic  acid.  Warm  distilled  water  is  now  added  and 
the  matters  filtered  through  paper.  The  filtrate  is  color- 
less, if  pure  ;  if  colored,  it  must  be  evaporated  to  dryness, 
treated  again  with  nitric  acid  and  water,  and  filtered  the  sec- 
ond time.  The  acid  liquid  must  next  be  evaporated  to  dry- 
ness, to  get  rid  of  the  nitrous  vapors.  It  should  now  be 
mixed  with  a  sufficient  quantity  of  water,  when  it  will  be  fit 
for  testing,  as  above  described. 

Method  of  Gautier  consists  of  moderately  heating  the 
tissue  or  organs,  finely  divided,  with  about  one  third  its 
weight  of  pure  nitric  acid,  on  a  porcelain  dish.  Now  lique- 
faction ensues  ;  pure  sulphuric  acid  is  now  added  (about 
one  sixth  part  of  the  nitric  acid),  when  violent  action  en- 
sues, and  the  mass  assumes  a  brownish  color.  It  is  then 
heated  till  vapors  of  sulphuric  acid  appear.  The  whole  is 
next  treated  with  small  portions  of  nitric  acid,  successively 
added,  which  causes  the  mass  to  liquefy,  with  the  escape  of 
nitrous  fumes.  It  is  next  heated  until  it  is  carbonized.  It 
is  then  pulverized,  and  exhausted  with  boiling  water,  and 
filtered.  The  solution  containing  arsenic  acid  is  next 
treated  with  sodium  sulphite,  and  precipitated  with  hydro- 
gen sulphid. 

Distillation  Process.  —  The  tissue  should  first  be  thor- 
oughly dried  over  a  water-bath,  and  then  mixed  with  about 
its  own  weight  of  pure  hydrochloric  acid,  and  distilled  in  a 
retort  over  a  sand-bath  almost   to    dryness,  the  distillate 


4/2  TOXICOLOGY. 

being  received  into  a  small  quantity  of  water  properly  re- 
frigerated. By  this  process  the  arsenic  is  separated  as 
arseiious  chlorid.  It  possesses  the  advantage  of  imme- 
diately separating  the  arsenic,  in  a  tolerably  pure  state,  from 
the  tissues.  The  distillate  may  be  subjected  to  all  the 
usual  tests. 

The  urine  can  be  examined  by  Reinsch's  test,  by  first 
concentrating  by  evaporation  ;  or  it  may  be  evaporated  to 
dryness,  and  then  treated  with  hydrochloric  acid  and  potas- 
sium chlorate,  and  examined  in  the  usual  way. 

Solutions  of  arsenical  compounds  often  mixed  with  zinc 
chlorid  are  now  used  by  undertakers  as  embalming  fluid. 

Arsenic  is  estimated  quantitatively  as  a  sulphid  ;  lOO 
grains  of  pure  dried  sulphid  represent  80.48  of  arsenous 
oxid. 

Fowler's  Solution.  —  This  preparation,  much  used  in 
medicine,  is  made  by  dissolving  arsenous  oxid  in  potassium 
carbonate  and  tincture  of  lavender.  It  contains  four  grains 
of  arsenous  oxid  to  the  fluid  ounce. 

Arsenic  Acid.  —  A  powerful  poison,  but  not  often  em- 
ployed as  such.  It  is  tested  as  arsenous  oxid  ;  with  hydro- 
gen sulphid  it  yields  a  yellow  precipitate  after  a  con- 
siderable time.  The  most  delicate  test  is  silver  nitrate, 
which  yields  a  brownish-red  precipitate  (silver  arsenate). 

Silliman  has  given  an  account  of  the  death  of  a  boy,  be- 
tween three  and  four  years  of  age,  from  sodium  arsenate,  a 
-poisonous  preparation  sold  in  New  York  under  the  name 
of  "  pest  poison,"  for  destroying  potato  bugs.  The  most 
singular  circumstance  connected  with  the  case  was  the  entire 
absence  of  all  the  usual  symptoms   of  arsenic  poisoning, 


PREPARATIONS    OF    ARSENIC.  473 

such  as  pain,  vomiting  and  purging,  etc.,  but,  on  the  con- 
trary, those  of  a  powerful  narcotic,  like  belladonna  or  stra- 
monium. There  were  profound  stupor,  dilatation  of  the 
pupils,  a  rapid  pulse,  and  hurried  respiration.  After  partial 
recovery  a  relapse  took  place,  the  child  dying,  apparently 
from  asphyxia,  about  nine  hours  after  swallowing  the 
poison. 

Copper  Arsenite.  —  Scheele's  Green.  —  A  fine  green 
powder,  insoluble  in  water,  but  soluble  in  acids  and  alkalies. 
By  sublimation  in  a  reduction-tube  it  yields  ciystals  of 
arsenous  oxid. 

Copper  Aceto-arsenite.  —  Sclnveinfiirth  or  Brunsivick 
Green.  —  Vienna  or  Emerald  Green.  —  Paris  Green.  —  A 
pigment  sometimes  used  for  staining  wall  paper,  bon-bon 
paper,  toys,  articles  of  dress,  artificial  flowers,  and  millineiy. 
Under  the  name  of  Paris  green  it  has  lately  become  the 
frequent  cause  of  deaths,  both  homicidal  and  suicidal.  It 
is  readily  identified  by  heating  it  in  a  test-tube,  when  it 
gives  off  fumes  of  acetic  acid,  deposits  crystals  of  arsenous 
oxid,  and  leaves  a  residue  of  oxid  of  copper. 

Paper  and  other  articles  colored  with  this  pigment  may 
be  easily  tested  by  dipping  them  into  a  weak  solution  of 
ammonium  hydroxid,  when  they  will  be  speedily  bleached, 
while  the  solution  will  become  blue.  If  now  a  ciystal  of 
silver  nitrate  be  placed  in  the  latter,  a  film  of  yellow  is  im- 
mediately formed  around  it  —  silver  arsenite.  A  drop  of 
ammonium  hydroxid  applied  to  paper  colored  by  this  pig- 
ment immediately  turns  it  blue. 

Chronic  arsenical  poisoning  is  a  frequent  result  of  living 
in  rooms  the  walls  of  which  are  covered  with  paper  colored 
40 


474  TOXICOLOGY. 

with  arsenical  colors  ;  the  fine  powder  or  dust  detached 
from  the  walls  is  inhaled  into  the  lungs,  and  produces  the 
symptoms  above  described. 

Sulphids.  —  Two  sulphids  are  found  as  minerals,  the 
yellow  arsenous  sulphid  (orpiment),  and  the  red  arsenous 
disulphid  (realgar).  Arsenous  sulphid  is  sometimes  taken 
as  a  poison.  They  are  both  soluble  in  alkalies,  and  when 
mixed  with  a  strong  reducing  agent  and  sublimed,  they 
yield  metallic  mirrors. 

Hydrogen  Arsenid.  —  This  is  a  gaseous  body  of  highly 
poisonous  character,  which  is  readily  produced  by  the 
action  of  nascent  hydrogen  on  arsenical  compounds.  It  is 
not  infrequently  found  as  an  impurity  in  hydrogen  obtained 
by  the  solution  of  zinc  in  sulphuric  acid.  Cases  of  poison- 
ing by  it  occur  among  chemists  and  among  operators  en- 
gaged in  chemical  industries.  The  principal  symptoms  are  : 
headache,  severe  lumbar  and  abdominal  pain,  vomiting, 
thirst,  suppression  of  urine,  and  bloody  urine.  The  cases 
are  usually  fatal  though  often  prolonged.  No  special  anti- 
dote is  known. 

ANTIMONY  COMPOUNDS. 

Tartar  Emetic  is  the  only  preparation  of  Antimony  of 
much  medico-legal  importance  ;  but  the  chlorid  is  occasion- 
ally a  cause  of  poisoning. 

Tartar  Emetic  {tartarized  antimony;  stibiated  tartar, 
antimony  potassium  tartrate).  —  This  body  is  of  rather  pecu- 
liar composition.  It  is  formed  from  tartaric  acid  by  replac- 
ing one  of  the  hydrogen  atoms  by  potassium  and  another 
by  antimony  monoxid,  a  radicle.      The  proper  name  would 


Antimony  compounds.  475 

be  potassium  antimonoxyl  tartrate.  It  occurs  in  large, 
colorless  ciystals  and  as  a  white  powder.  The  commercial 
salt  sometimes  contains  traces  of  arsenic.  Heated  in  a  re- 
duction-tube it  blackens,  and  is  reduced  to  a  mixture  of 
carbon  and  antimony.  Heated  on  charcoal,  before  the 
blowpipe,  it  is  also  reduced,  yielding  globules  of  antimony, 
along  with  a  white  incrustation  of  the  oxid.  It  is  soluble 
in  three  parts  of  boiling  and  fifteen  of  cold  water ;  its  solu- 
tion slowly  undergoes  decomposition.  It  is  insoluble  in  al- 
cohol;    The  taste  is  nauseous,  metallic,  and  acrid. 

Symptoms.  —  A  harsh,  metallic  taste  is  perceived  on  swal- 
lowing, soon  followed  by  nausea,  retching,  violent  and  inces- 
sant vomiting,  great  thirst,  constriction  of  the  throat,  burning 
pain  in  the  stomach  and  abdomen,  and  profuse  purging  of 
a  watery  character ;  sometimes  blood  is  found  in  the  dis- 
charges both  from  the  stomach  and  bowels  ;  severe  cramps 
in  the  extremities,  a  very  feeble,  rapid  pulse,  profuse  per- 
spiration, extreme  prostration,  with  a  disposition  to  syncope. 
The  urine  is  generally  increased  in  quantity,  but  is  voided 
with  pain  ;  at  times  there  may  be  delirium  and  convulsions 
preceding  death.  In  exceptional  cases,  there  is  an  absence 
of  vomiting  and  purging,  the  symptoms  being  those  of  ex- 
treme collapse,  with  a  cold,  clammy  sweat,  feeble  respira- 
tion, irregular  pulse,  delirium,  unconsciousness,  and  tetanic 
convulsions. 

An  occasional  symptom  is  noted  if  the  patient  survives 
three  or  four  days  ;  a  pustular  eruption  over  the  body, 
similar  to  that  produced  by  the  external  application  of  the 
substance. 

In  some  instances  it  appears  to  exert  a  slightly  corrosive 
impression,  causing  aphthous  ulceration  of  the  tongue  and 
inside  of  the  mouth.     While  acting  as  an  irritant  to   the 


476  TOXICOLOGY. 

gastro -enteric  mucous  membrane,  it  undoubtedly  exerts  a 
depressant  effect  upon  the  heart. 

Fatal  Dose.  —  This  has  not  been  precisely  determined. 
In  some  cases,  two  or  three  grains  have  produced  alarming 
and  even  fatal  effects,  whilst  in  others  enormous  doses,  up 
to  an  ounce,  have  failed  to  destroy  life.  Large  doses,  by 
exciting  speedy  vomiting,  generally  relieve  themselves. 
Probably  twenty  to  forty  grains  may  be  regarded  as  the 
usual  minimum  fatal  dose  for  an  adult. 

Fatal  Period.  —  From  an  hour  up  to  several  days.  In  an 
exceptional  case  related  by  Deutsch,  a  woman  took  by  mis- 
take a  scruple  of  tartar  emetic,  and  died  one  year  afterward 
from  the  irritant  effects  on  the  alimentary  canal. 

Post-mortem  Appearances.  —  The  irritant  effects  of  this 
poison  are  displayed  upon  the  lining  membrane  of  the 
stomach  and  bowels,  which  is  deeply  reddened,  softened, 
and  covered  with  a  blackish,  thick,  and  viscid  secretion, 
sometimes  streaked  with  blood.  The  throat,  esophagus, 
stomach,  and  bowels  also  exhibit  aphthous-looking  spots, 
or  excoriations,  and  occasionally  true  pustules  may  be  seen 
scattered  throughout  the  intestinal  tract. 

The  liver  is  generally  enlarged  and  softened,  and  seems 
to  have  undergone  a  fatty  degeneration.  It  is  stated  that 
the  natives  of  Brunswick  feed  their  geese  upon  antimony 
oxid,  for  the  purpose  of  fattening  them  by  increasing  the 
size  of  their  livers.  The  lungs  are  often  deeply  congested, 
sometimes  exhibiting  a  true  apoplexy.  The  mucous  lining 
of  the  windpipe  and  bronchi  is  uniformly  reddened.  The 
brain  is  generally  congested,  both  in  its  membranes  and 
substance,  the  latter  presenting,  when  cut,  numerous  bloody 
points.  The  ventricles  occasionally  contain  an  excess  of 
serum,  and  there  may  also  be  some  submeningeal  serous 


ANTIMONY    COMPOUNDS.  477 

effusion.  The  heart  exhibits  nothing  abnormal.  Accord- 
ing to  some  authorities  the  blood  retains  its  fluidity. 

Treatment. — Vomiting  should  be  assisted  by  warm  mu- 
cilaginous drinks,  or  the  stomach-pump  may  be  employed. 
The  proper  antidote  is  tannin,  in  the  form  of  some  astrin- 
gent vegetable  infusion,  such  as  green  tea  or  nutgalls. 
Afterward  opium  and  stimulants  will  be  necessary. 

Chronic  Poisoning.  —  This  method  of  poisoning  is  believed 
to  be  somewhat  frequent.  The  symptoms  are  a  distressing 
nausea,  with  occasional  vomiting,  diarrhea  with  pasty 
stools,  loss  of  appetite,  emaciation,  slimy  tongue,  feeble 
action  of  the  heart,  difficult  breathing,  a  pale  and  anxious 
countenance,  faintings  with  increased  perspiration  and 
urination. 

Extejmal  Application. — When  applied  to  the  skin,  tartar 
emetic  occasions  deep  pustulation  ;  it  is  also  readily  ab- 
sorbed, especially  from  abraded  surfaces,  and  produces  all 
its  constitutional  effects  the  same  as  if  swallowed,  such  as 
nausea,  vomiting,  debility,  etc.  Fatal  effects  have  thus  re- 
sulted, and  the  poison  has  been  detected,  after  death,  in 
the  stomach,  liver,  kidneys,  and  other  organs. 

Analytic  Methods.  —  \.  As  a  solid.  — Touched  with  a  drop 
of  ammonium  sulphid,  or  a  solution  of  hydrogen  sulphid,  it 
immediately  acquires  an  orange-red  color  ;  this  is  character- 
istic of  all  the  salts  of  antimony  in  their  pure  state.  Heated 
in  a  reduction-tube,  it  blackens. 

2.  In  solution.  —  {a)  A  drop  of  a  strong  solution,  evapo- 
rated on  glass,  will  exhibit  the  tetrahedral  crystals  ;  a  weak 
solution  gives  a  mass  of  confused  crystals.  {U)  Either  of 
the  mineral  acids  dropped  into  it  produces  a  white  precipi- 
tate, soluble  in  an  excess  of  the  acid  ;  this  precipitate  is  also 
soluble  in  tartaric  acid,     {c)  Acidulated  with  hydrochloric 


478  TOXICOLOGY. 

acid,  and  boiled  on  bright  copper  foil,  the  latter  acquires 
a  violet-colored  deposit  of  antimony  (Reinsch's  test). 
(d)  The  above  solution  imparts  a  black  stain  to  a  strip  of 
pure  tin  foil  in  the  cold,  whereby  it  is  distinguished  from 
arsenic.  {e)  Hydrogen  sulphid  or  ammonium  sulphid 
throws  down  from  a  pure  solution  a  characteristic  orange- 
red  precipitate  of  antimonous  sulphid.  This  precipitate  is 
soluble  in  sodium  hydroxid,  but  scarcely  so  in  ammonium 
hydroxid ;  insoluble  in  dilute  hydrochloric  acid ;  but  if 
boiled  in  the  concentrated  acid,  it  is  decomposed  with  the 
escape  of  hydrogen  sulphid  and  the  formation  of  anti- 
monous chlorid.  The  resulting  solution,  if  not  too  acid, 
when  dropped  into  water  immediately  throws  down  a 
copious,  white,  flaky  precipitate  (the  oxychlorid,  or  powder 
of  Algaroth),  which  is  quite  characteristic.  This  may  be 
identified  (i)  by  its  solubiHty  in  tartaric  acid  ;  (2)  by  touch- 
ing it  with  ammonium  sulphid,  which  imparts  to  it  an 
orange-red  color.  The  white  precipitate  obtained  by 
dropping  the  bismuth  nitrate  into  water  is  not  soluble  in 
tartaric  acid,  and  is  blackened  by  ammonium  sulphid. 
(/")  Galvanic  Test.  —  This  is  made  by  placing  a  ^qw  drops  of 
the  solution,  acidified  by  hydrochloric  acid,  upon  a  platinum 
capsule,  and  touching  the  latter,  through  the  liquid,  with  a 
strip  of  bright  zinc ;  metallic  antimony  is  deposited  on  the 
platinum  at  the  point  of  contact  as  a  brownish  or  black 
film.  The  liquid  should  then  be  poured  off  and  the  plat- 
inum washed  in  distilled  water.  A  small  quantity  of  ammo- 
nium sulphid,  poured  upon  the  stain,  speedily  dissolves  it 
(if  antimony)  by  the  aid  of  heat,  and  on  evaporation  an 
orange-red  sulphid  remains.  A  modification  of  this  test 
may  be  advantageously  applied  for  the  detection  of  anti- 
mony in  the  organs. 


ANTIMONY CHEMICAL    ANALYSIS.  4/9 

(Ji)  Marsh's  Test.  —  If  a  solution  of  antimony  compound 
be  subjected  to  the  action  of  nascent  hydrogen,  hydrogen 
antimonid  (stibin)  is  generated  in  precisely  the  same  manner 
as  is  hydrogen  arsenid  under  the  same  conditions. 

I .  If  the  gas  is  burned  at  the  jet,  it  gives  a  bluish  flame, 
evolving  white  fumes  of  antimonous  oxid,  and  if  these  fumes 
are  received  into  a  short,  wide  test-tube,  held  just  above 
the  flame,  the  white  deposit  of  the  oxid  may  be  collected, 
which  may  be  identified  by  ammonium  sulphid.  If  a  piece 
of  cold,  white  porcelain  be  held  horizontally  just  within 
the  flame,  the  metal  is  deposited  (as  in  the  case  of  arsenic) 
in  the  form  of  a  black,  or  nearly  black,  spot,  which  is 
usually  surrounded  by  a  grayish  ring.  These  deposits 
may  be  multiplied  by  simply  changing  the  position  of  the 
porcelain. 

The  only  fallacy  to  which  this  test  is  liable  is  from 
arsenic,  which,  as  has  been  shown,  behaves  in  a  somewhat 
similar  manner.  But  they  can  readily  be  distinguished  from 
one  another  by  a  little  attention.  The  antimony  deposit  is, 
as  a  rule,  blacker  and  less  brilliant  than  that  of  arsenic  ;  but 
if  the  spots  of  antimony  are  extremely  small,  this  dis- 
tinction is  not  so  observable.  Again,  the  antimony  stains 
are  more  slowly  dissipated  by  heat  than  with  arsenic  ;  the 
former  immediately  dissolve  in  a  drop  of  ammonium  sulphid, 
leaving  on  evaporation  an  orange-red  deposit ;  the  latter 
(arsenic)  are  slowly  affected  by  it,  and  leave  on  evaporation 
a  yellow  residue.  Furthermore,  the  arsenic  deposit  is  im- 
mediately soluble  in  a  solution  of  sodium  hypochlorite, 
which  has  little  or  no  effect  upon  the  antimony  stain. 
Nitric  acid  will  also  serve  to  distinguish  them  ;  both  are 
dissolved  by  it,  but  on  evaporation  to  dryness  the  arsenic 
residue  gives  to  a  solution  of  silver  nitrate  a  brick-red  color 


480  TOXICOLOGY. 

(silver  arsenate),  but  the  antimonial  residue  is  not  affected 
by  it. 

2.  If  heat  be  applied  to  the  horizontal  tube  in  Marsh's 
apparatus,  during  the  passage  of  the  gas,  decomposition 
takes  place,  as  in  the  case  of  arsenic  ;  but  the  deposition  of 
the  antimonial  mirror  occurs  immediately  over  and  around 
the  heated  portion,  and  not  in  advance  of  it.  If  the  quan- 
tity operated  upon  is  very  small,  the  deposit  may  take  place 
wholly  within  the  point  of  heat.  These  deposits  exhibit 
the  same  chemical  reactions  as  those  produced  on  porcelain 
by  the  flame. 

3.  If  the  hydrogen  antimonid  be  passed  into  a  solution 
of  silver  nitrate,  the  latter  (as  in  the  case  of  arsenic)  becomes 
black,  the  whole  of  the  antimony  is  precipitated  as  silver 
antimonid  (with  hydrogen  arsenid,  the  precipitate  consists 
of  silver,  arsenous  oxid  being  in  solution).  This  black 
precipitate  should  be  collected  on  a  filter,  washed  and  boiled 
with  dilute  hydrochloric  acid,  which  dissolves  out  the  anti- 
mony and  leaves  the  silver.  On  filtering  the  solution  and 
treating  it  with  hydrogen  sulphid,  the  characteristic  orange- 
red  sulphid  is  precipitated. 

Toxicologic  Examination.  —  In  certain  cases  it  might  be 
desirable  to  separate  the  tartar  emetic,  as  such,  from  the 
stomach  ;  this  may  sometimes  be  accomplished  by  dialysis. 
For  all  practical  purposes  it  is  deemed  sufficient  if  the 
analyst  can  detect  the  antimony.  The  process  of  dialysis 
may  also  be  employed  to  separate  tartar  emetic  from  food 
and  vomited  matters,  but  not,  of  course,  for  detecting 
absorbed  antimony  in  the  tissues. 

The  stomach,  properly  divided,  and  contents  should  be 
acidulated  with  tartaric  acid,  and  gently  heated  with  suffi- 
cient  distilled  water   over  a  water-bath  for  about  half  an 


ANTIMONY TOXICOLOGIC    EXAMINATION.  48  I 

hour.  When  cold,  the  matters  should  be  strained  through 
muslin  ;  the  solid  portions  are  to  be  washed  and  pressed, 
and  the  whole  of  the  liquid  carefully  evaporated  to  about 
one  half.  Trial  tests  may  now  be  made  on  a  portion  of  this 
liquid  ((«)  by  inserting  a  piece  of  pure  tin  foil  in  the  cold  ; 
it  will  soon  blacken  if  antimony  is  present ;  {b)  acidulate 
with  hydrochloric  acid,  boil  and  introduce  a  piece  of  bright 
copper  foil  (Reinsch's  test)  ;  it  will  speedily  acquire  a  violet 
stain,  [c)  The  remainder  of  the  Hquid,  slightly  warmed, 
should  be  treated  with  hydrogen  sulphid  for  several  hours  ; 
a  dirty  orange  red  or  brown  precipitate  will  be  thrown 
down,  consisting  of  antimonous  sulphid,  organic  matter,  and 
reduced  sulphur.  The  mere  production  of  a  reddish-brown 
deposit  under  these  circumstances  is  not  sufficient  to  estab- 
lish the  presence  of  the  antimony  ;  what  has  been  said  upon 
this  point  under  the  head  of  arsenic  applies  with  equal  force 
to  antimony. 

The  impure,  dark-colored  precipitate  should  be  washed, 
treated  on  a  porcelain  capsule  with  a  little  pure  nitric  acid, 
and  carefully  evaporated  to  dryness  ;  the  operation  to  be 
repeated  until  all  the  organic  matter  is  destroyed.  The 
residue  is  then  moistened  with  potassium  hydroxid  heated 
moderately,  and  the  mixture  gradually  fused.  The  cooled 
mass  is  stirred  in  a  little  water  acidulated  with  tartaric  acid, 
boiled  and  filtered.  The  solution  should  be  colorless.  This 
may  then  be  employed  for  Marsh's  method,  or  with  hydro- 
gen sulphid  ;  in  the  latter  case  the  precipitate  ought  to 
exhibit  the  characteristic  pure  orange-red  color. 

It  may  be  remarked  here  that  in  every  case  of  poisoning 
with  antimony  (as  indeed  with  some  other  substances),  the 
actual  obtaining  of  the  characteristic  element  as  a  specimen 
is  usually  insisted .  on  as  absolute  and  unequivocal  proof; 


482  TOXICOLOGY. 

and  this,  too,  in  quantities  sufficient  to  admit  of  its  positive 
identification  by  all  the  recognized  tests.  This  is  not  con- 
sidered a  mere  arbitrary  or  capricious  rule.  The  highest 
authorities,  such  as  Orfila,  Tardieu,  and  Taylor,  sanction  it. 
Besides,  the  extraction  of  the  antimony  is  not  difficult,  e.g., 
by  tin  foil,  by  galvanism,  by  Marsh's  and  Reinsch's  proc- 
esses, and  by  the  blowpipe. 

In  the  Organs  and  Tissues.  —  Most  of  the  absorbed 
poison  will  be  found  in  the  liver  and  kidneys.  A  given 
portion  of  these  organs,  properly  divided,  should  be  boiled 
in  water  acidulated  with  about  one  sixth  of  hydrochloric 
acid.  After  proper  concentration,  trial  tests  may  be  made 
with  a  strip  of  tin  foil  in  the  cold,  and  copper  foil  in  the 
boiling  solution.  If  any  indications  of  antimony  are  given, 
Reinsch's  process  may  be  carried  out  by  subjecting  a 
number  of  pieces  of  copper  to  the  boiling  acid  liquid. 
These  should  be  thoroughly  washed  and  dried  between 
the  folds  of  bibulous  paper ;  then  rolled  up  and  intro- 
duced into  glass  reduction-tubes,  and  heated  by  the  flame 
of  a  spirit-lamp ;  a  white  sublimate  will  be  deposited  on 
the  cool  portion  of  the  tube,  as  in  the  case  of  arsenic  ; 
but  it  is  either  amorphous  or  else  composed  of  veiy  fine 
acicular  crystals. 

The  true  nature  of  this  antimony  deposit  is  best  shown, 
according  to  Watson,  by  boiling  the  coated  copper  in  a 
dilute  solution  of  potassium  hydroxid,  the  metal  being 
occasionally  withdrawn  from  the  liquid  and  exposed  to  the 
air  to  favor  oxidation,  when,  after  a  time,  the  whole  of  the 
antimony  will  be  in  solution.  The  copper  strip  should  now 
be  removed,  the  solution  acidulated  with  hydrochloric  acid, 
and  hydrogen  sulphid  passed  through  the  liquid,  when  the 


ANTIMONY IN    THE    ORGANS    AND    TISSUES,  483 

antimonic  sulphid,  mixed  with  antimonous  sulphid  and 
sulphur,  will  be  thrown  down  as  an  orange-red  precipitate. 
The  whole  of  the  antimony  may  be  thus  removed  by  em- 
ploying successive  strips  of  copper  and  subjecting  them  to 
the  above  treatment ;  or  the  acidulated  mixture  may  be 
boiled  with  potassium  chlorate  and  subsequently  treated  as 
in  the  case  of  arsenic. 

The  galvanic  test  may  also  be  applied  with  great  advan- 
tage to  detect  the  presence  of  antimony  in  the  tissues, 
Taylor's  plan  is  an  excellent  one  :  Coil  a  portion  of  pure 
zinc  foil  around  a  piece  of  clean  platinum  foil,  and  suspend 
them  in  the  acid  solution  of  the  tissues,  sufficiently  dilute 
to  prevent  too  violent  an  action  on  the  zinc.  The  liquid 
should  be  warmed.  Sooner  or  later,  according  to  the 
quantity  present,  the  platinum  will  be  coated  with  an  ad- 
hering black  powder  of  antimony  ;  or  the  solution,  properly 
acidified,  may  be  placed  in  a  platinum  dish  and  a  zinc  rod 
introduced  ;  after  a  sufficient  time  the  antimony  will  be 
deposited  on  the  platinum.  Wash  the  platinum  foil,  and 
digest  it  in  strong  nitric  acid,  which  will  dissolve  off  the 
antimony ;  remove  the  platinum  and  evaporate  to  dryness. 
Redissolve  the  residue  in  hydrochloric  acid,  dilute  the 
solution,  and  treat  with  hydrogen  sulphid,  which  will  pre- 
cipitate the  pure  sulphid  ;  or  the  deposit  on  the  platinum 
may  be  dissolved  off  by  ammonium  sulphid. 

The  absorbed  antimony  may  also  be  extracted  by  means 
of  potassium  chlorate  and  hydrochloric  acid.  In  this  case, 
in  the  subsequent  application  of  hydrogen  sulphid,  there  is 
no  occasion  to  employ  sulphurous  acid  to  effect  a  reduction 
to  a  lower  oxid,  as  in  the  case  of  arsenic. 

It  has  been  ascertained  that  antimony  may  be  eliminated 
through  the  glands  of  the  stomach,  even  when  introduced 


484  '  TOXICOLOGY. 

into  the  system  by  some  other  avenue  —  e.  g.,  by  hydrogen 
antimonid  through  the  lungs. 

The  imne  should  always  be  examined  in  cases  of  sus- 
pected antimonial  poisoning.  This  secretion  is  very  soon 
affected  by  antimony  compounds,  and  it  may  contain  traces 
of  them  for  some  time  after  their  discontinuance.  The 
urine  should  be  evaporated  nearly  to  dryness,  when  it  may 
be  examined  either  by  Reinsch'5  test,  by  tin  foil,  by  the 
galvanic  test,  by  Marsh's  process,  by  potassium  chlorate 
and  hydrochloric  acid  with  hydrogen  sulphid,  and  by  car- 
bonizing with  sulphuric  acid. 

Antimonous  Chlorid  {Butter  of  Antimony).  —  This  is  a 
strong,  corrosive  poison,  and  has  proved  fatal  in  a  number 
of  instances.  The  symptoms  and  post-mortem  lesions 
resemble  those  of  the  corrosive  acids  rather  than  those 
produced  by  tartar  emetic.  When  thrown  into  water,  the 
oxychlorid  is  generated,  and  falls  as  a  copious,  white,  flaky 
precipitate.  This  is  soluble  in  tartaric  acid,  and  is  instantly 
colored  orange-red  when  touched  with  ammonium  sulphid. 
The  clear  liquid  contains  hydrochloric  acid,  as  shown  by 
silver  nitrate,  which  precipitates  silver  chlorid. 

Antimony  is  estimated  quantitatively  as  an  antimonous 
sulphid.  Every  100  grains  of  pure  antimonous  sulphid  are 
equivalent  to  85.75  of  the  antimonous  oxid  or  192.19  of 
anhydrous  tartar  emetic. 

MERCURY   COMPOUNDS. 
Mercury  is  not  poisonous  in  the  free  state,  unless  veiy 
finely  divided.      It  has  been  administered  to  relieve  consti- 
pation.    The  vapor  is  poisonous,  and  as  this  may  be  given 
off  even  at  ordinary  temperatures,  it  happens  that  looking- 


MERCURY    COMPOUNDS.  485 

glass  platers  and  barometer  and  thermometer  makers  are 
very  liable  to  become  poisoned  by  the  fumes.  Cases  of  this 
form  of  poisoning  have  occurred  among  makers  of  vacuum 
electric  lamps,  for  which  a  mercurial  pump  is  employed. 
The  symptoms  of  this  sort  of  poisoning  may  come  on 
gradually  or  suddenly  ;  they  may  or  may  not  be  accom- 
panied with  salivation.  They  are  chiefly  marked  by  the 
production  of  tremors  of  the  limbs  and  paralysis,  indicating 
the  action  of  the  metal  on  the  nerve-centers.  The  general 
condition  thus  induced  is  named  mercurial  tremors  and 
shaking  palsy.  The  upper  extremities  are  usually  first 
affected,  and  then,  by  degrees,  all  the  muscles  of  the  body. 
There  is  an  unsteadiness  in  the  arms  and  legs,  so  that  the 
patient  cannot  grasp  an  object,  nor  walk  firmly  on  the 
ground.  In  bad  cases  he  can  neither  speak  nor  chew  his 
food.  If  the  disorder  be  not  checked,  it  proceeds  to  a  fatal 
termination,  attended  with  a  loss  of  memory,  insomnia  and 
delirium.  Another  curious  symptom,  not  generally  recog- 
nized, but  usually  present,  is  a  brittle  state  of  the  teeth, 
causing  them  to  chip. 

The  proper  prophylactic  treatment  in  this  affection  con- 
sists in  cleanliness  and  good  ventilation,  together  with  the 
free  internal  use  of  albumin  in  the  form  of  white  of  eggs. 

All  the  mercurial  compounds  are  more  or  less  poisonous, 
but  the  most  important  one  is  corrosive  sublimate. 

Corrosive  Sublimate  {Mercuric  Chlojid).  —  Occurs  either 
in  heavy  ciystalline  masses  of  prismatic  crystals,  or  as  a 
white  powder.  It  has  a  powerful  styptic,  nauseous  taste, 
and  is  soluble  in  about  thirteen  parts  of  cold  and  three 
of  boiling  water.  Alcohol  and  ether  still  more  freely  dis- 
solve it,  and  the  latter  has  the  power  of  abstracting  it  from 
its  aqueous  solution. 


486  TOXICOLOGY. 

Symptoms.  —  These  usually  come  on  immediately  after 
taking  the  poison.  A  strong,  metallic,  styptic  taste  is  per- 
ceived, with  a  sense  of  heat  and  choking  in  the  throat.  A 
fierce,  burning  pain  is  felt,  extending  from  the  mouth  to 
the  stomach  ;  nausea,  retching,  and  vomiting  of  stringy 
mucus,  often  tinged  with  blood ;  pain  in  the  abdomen, 
which  is  usually  swollen  and  tender  to  the  touch  ;  severe 
purging,  sometimes  of  bloody  matters,  accompanied  with 
tenesmus,  as  in  dysentery.  The  pulse  is  feeble,  quick,  and 
irregular  ;  countenance  flushed  and  swollen,  though  some- 
times it  is  pale  and  anxious  ;  the  tongue  is  white  and  shriv- 
eled ;  skin  cold  and  clammy  ;  respiration  difficult ;  intense 
thirst ;  urine  scanty  or  suppressed  ;  cramps  of  the  extremi- 
ties ;  stupor,  fainting,  convulsions,  and  death.  Salivation  is 
apt  to  appear  on  the  second  or  third  day,  but  it  is  not  an 
invariable  symptom  in  acute  cases.  In  exceptional  in- 
stances there  has  been  an  absence  of  abdominal  pain,  as  also 
of  vomiting  and  purging. 

Poisoning  from  corrosive  sublimate  differs  from  arsenical 
poisoning  :  (i)  The  former  poison  has  a  very  distinct  acrid 
taste,  while  the  latter  is  almost  tasteless.  (2)  The  symp- 
toms of  the  former  come  on  almost  immediately  after  it  is 
swallowed  ;  those  produced  by  the  latter  are  generally 
postponed  from  half  an  hour  to  an  hour.  (3)  The  dis- 
charges from  corrosive  sublimate  poisoning  are  more  fre- 
quently bloody  than  those  from  arsenic. 

The  external  application  of  corrosive  sublimate  has  often 
been  attended  with  fatal  consequences,  and  both  the  symp- 
toms and  post-mortem  lesions  in  such  cases  resemble  those 
produced  by  swallowing  the  poison,  such  as  vomiting,  purg- 
ing, suppression  of  urine,  salivation,  etc.,  injection  of  the 
stomach    and   kidneys,    with   ecchymoses    throughout  the 


CORROSIVE    SUBLIMATE.  48/ 

intestines  and  bladder.  Cases  of  this  character,  resulting 
fatally,  are  reported  where  a  solution  of  corrosive  sublimate 
was  applied  to  the  scalps  of  children,  for  the  cure  of  porrigo 
and  ringworm.  The  recent  antiseptic  use  of  the  dilute 
solution,  by  the  surgeon,  has  occasionally  produced  poison- 
ous results. 

Fatal  Dose.  —  The  minimum  fatal  dose  for  an  adult  may 
be  considered  to  be  three  grains,  although,  as  in  the  case  of 
other  mineral  poisons,  very  large  quantities  have  been  taken 
with  impunity,  having  been  speedily  vomited  or  promptly 
neutralized  by  proper  antidotes. 

Fatal  Period.  —  Taylor  reports  the  shortest  period  on 
record,  where  death  occurred  in  half  an  hour  from  an  un- 
known quantity  of  the  poison.  In  the  majority  of  cases  life 
is  prolonged  for  several  days  —  from  one  to  five.  In  a  sum- 
mary of  cases  given  by  Guy,  about  half  the  number  died  in 
less  than  twelve  hours,  and  the  remaining  half  in  a  period 
varying  from  three  to  eleven  days.  More  than  one  half  of 
the  cases  terminate  fatally. 

Treatment.  —  Promote  vomiting  by  the  free  use  of  warm 
diluent  drinks.  The  proper  antidote  is  albumin,  as  found 
in  eggs.  This  decomposes  the  mercurial  salt,  forming  an 
insoluble  albuminate  ;  a  large  excess  of  albumin  will  redis- 
solve  the  precipitate.  The  white  of  one  o.^^  is  supposed  to 
be  capable  of  neutralizing  four  grains  of  corrosive  sub- 
Hmate.  In  the  absence  of  eggs,  glutin  or  wheat  flour,  in  the 
form  of  paste,  may  be  freely  exhibited.  Milk  may  also  be 
freely  used. 

Post-mortem  Appearances.  —  These  are  generally  confined, 
as  in  the  case  of  arsenic,  to  the  mucous  membrane  of  the 
stomach  and  bowels  ;  but  the  corrosive  action  of  the  mer- 
curial is  more  marked.     The  stomach,  together  with  the 


488  TOXICOLOGY, 

mouth,  throat,  and  esophagus,  is  often  softened,  of  a  white 
or  grayish  color,  and  corroded.  The  intestines,  especially 
the  cecum,  often  exhibit  similar  appearances.  Perforation 
of  the  stomach  is  rare.  The  kidneys  and  bladder  are  usually 
highly  inflamed,  the  former  especially  congested  about  the 
Malpighian  bodies,  and  the  epithelial  cells  deformed,  gran- 
ular, and  partially  destroyed.  The  bladder  is  empty  and 
contracted. 

Byasson  states  that  corrosive  sublimate  takes  two  hours 
to  reach  the  urine,  and  four  hours  to  reach  the  saliva.  He 
never  found  it  in  the  perspiration.  He  considers  it  to  be 
completely  eliminated  in  twenty-four  hours  after  it  has 
been  taken. 

In  chronic  or  slow  mercurial  poisoning  the  symptoms 
generally  presented  are  loss  of  appetite,  metallic  taste  in 
the  mouth,  fetid  breath,  soreness  of  the  gums,  increase  of 
salivaiy  secretion,  pain  in  the  stomach  and  abdomen,  with  , 
diarrhea,  quick  pulse,  hot  skin,  weakness,  and  emaciation. 
A  bluish  line  has  been  •  noticed  at  the  edge  of  the  gums,  as 
in  lead  poisoning. 

Salivation,  although  often  absent  in  acute  mercurial  poi- 
soning, is  nearly  always  observed  in  the  chronic  form.  As 
this  symptom  accompanies  the  use  of  any  other  drugs,  it 
cannot,  of  itself,  be  regarded  as  a  proof  of  the  administra- 
tion of  mercury.  In  a  doubtful  case  the  matter  may 
always  be  decided  by  a  chemical  examination  of  the  saliva 
for  mercury.  Doubtless  other  mineral  poisons  are  ehm- 
inated  by  this  secretion,  and  their  presence  might  be 
detected  in  it  with  proper  attention. 

The  relationship  between  salivation  and  mercurial  poi- 
soning is  a  subject  of  considerable  importance,  since 
charges  of  malpractice  have  often  been  made  against  phy- 


CHRONIC    MERCURIAL    POISONING.  489 

sicians  in  cases  of  profuse  and  fatal  salivation,  accompanied 
by  necrosis  and  gangrene,  in  which,  in  some  instances,  no 
mercury  whatever  had  been  administered,  and  in  others 
where  the  dose  has  been  exceedingly  small.  It  is  well 
known  that  there  is  no  fixed,  definite  period  when  the 
salivation  comes  on  ;  rarely  before  two  days,  often  later. 
In  a  case  reported  by  Wood,  in  which  a  teaspoonful  of  cor- 
rosive sublimate  had  been  swallowed,  salivation  was  profuse 
in  the  course  of  a  few  hours.  It  has  been  suggested  that 
this  very  early  flow  of  saliva  was  probably  due  rather  to 
the  local  irritant  action  of  the  poison  than  to  the  result  of 
absorption. 

An  important  fact  not  to  be  lost  sight  of  in  this  relation 
is  that  salivation  may  be  produced  by  various  other  agents 
besides  mercurials,  such  as  potassium  iodid,  iodin,  the  prep- 
arations of  copper,  lead,  bismuth,  arsenic,  antimony,  digi- 
talis, croton  oil,  cantharides,  colchicum,  and  other  drugs. 
A  case  has  been  mentioned  to  the  author  where  a  patient 
was  profusely  salivated  by  a  single  dose  of  five  grains  of 
potassium  iodid.  It  is  true  that  in  the  majority  of  the 
instances  of  non -mercurial  salivation  there  is  an  absence 
of  the  usual  mercurial  fetor  of  the  breath  and  the  coppery 
taste,  but  it  would  appear  from  some  recorded  cases  that 
these  symptoms  have  been  equally  noticed  in  the  salivation 
produced  by  arsenic  and  bismuth. 

Another  point  of  consideration  is  the  great  difference  in 
the  susceptibility  of  persons  to  the  mercurial  impression. 
Thus  it  is  almost  impossible  to  sahvate  a  very  young, 
healthy  child.  Certain  morbid  conditions  of  the  system, 
however,  such  as  anemia  and  albuminuria,  seem  to  predis- 
pose to  its  action.  A  dose  of  compound  cathartic  pills  (con- 
taining only  three  grains  of  calomel)  has  been  known  to  pro- 
41 


490  TOXICOLOGY. 

duce  very  severe  ptyalism.  Christison  states  that  three 
five-grain  doses  of  blue  pill,  one  eveiy  night,  proved  fatal ; 
and  that  two  grains  of  calomel  have  caused  ulceration  of 
the  throat,  exfoliation  of  the  jaw,  and  death.  Such  severe 
results  are,  however,  quite  infrequent. 

Mercurial  salivation  may  be  intermittent,  ceasing  for  a 
time  and  reappearing  without  the  further  exhibition  of  the 
medicine  during  the  interval. 

Furthermore,  salivation  may  arise  spontaneously  from 
mechanical  irritation  of  the  mouth,  or  as  the  result  of  ex- 
hausting diseases,  especially  among  the  children  of  poverty 
and  squalor,  who  are  surrounded  by  bad  hygienic  influences. 
Among  the  last-named  subjects,  the  two  diseases,  cmicrum 
oris  and  gangrene  of  the  mouth,  are  of  frequent  occur- 
rence. The  symptoms  of  these  conditions  strongly  resem- 
ble a  very  severe  case  of  mercurial  ptyalism,  so  that  the 
diagnosis  may  be  difficult.  If,  in  such  a  case,  the  physician 
should  have  happened  to  have  administered,  at  the  beginning 
of  the  sickness,  even  a  small  dose  of  calomel,  it  might  easily 
become  a  serious  question  to  determine  whether  the  death 
actually  resulted  from  the  mercury  acting  as  a  poison  or 
from  the  disease  ;  and  it  would  be  no  difficult  matter  to  get 
up  an  action  against  the  medical  man  for  malpractice. 
Taylor  cites  a  case  in  point.  A  charge  was  made  against  a 
medical  practitioner  for  having  caused  the  death  of  a  child, 
aged  four  years,  by  administering  an  overdose  of  some  mer- 
curial preparation  for  the  treatment  of  whooping-cough. 
On  the  fourth  day  the  child  complained  of  soreness  of  the 
mouth ;  the  teeth  became  loose  and  fell  out  ;  the  tongue 
and  cheek  very  much  swollen,  and  the  child  died,  in  the 
course  of  a  few  days,  from  gangrene  of  the  left  cheek.  The 
answer  to  the  charge  was  that  not  a  particle  of  mercury 


NON-MERCURIAL    SALIVATION.  49 1 

had  been  given  —  a  fact  clearly  proved  from  the  prescrip- 
tion-book of  the  medical  attendant.  This  was  evidently  an 
instance  in  which  gangrene  from  spontaneous  causes  had 
been  mistaken  for  mercurial  poisoning.  As  before  observed, 
the  chemical  analysis  of  the  saliva  would  settle  any  ques- 
tion of  this  kind. 

Analytic  Methods. — (i)  As  a  solid. — {a)  A  fragment 
heated  on  platinum  foil  is  entirely  dissipated  in  white,  acrid 
fumes,  which  condense  on  a  cool  surface  in  white,  radiating 
crystals,  (d)  Touched  with  a  drop  of  sodium  hydroxid  solu- 
tion, it  turns  yellowish  ;  calomel,  under  similar  circumstances, 
becomes  black,  (f)  A  solution  of  potassium  iodid  imparts 
a  bright  scarlet  color ;  this  is  a  very  delicate  test.  A  drop 
of  this  latter  solution  placed  upon  a  piece  of  bright  copper, 
in  contact  with  the  smallest  fragment  of  corrosive  sublimate, 
will  produce  a  bright,  silvery  stain  upon  the  copper,  espe- 
cially if  it  be  rubbed  with  the  finger  ;  this  stain  is  imme- 
diately removed  by  heating  it.  (<^)  Ammonium  sulphid  at 
first  turns  it  yellowish,  but  subsequently  black,  (e)  Heated 
in  a  reduction  tube  with  dried  sodium  carbonate  it  sublimes, 
forming  a  white  ring  on  the  cool  part  of  the  tube,  which, 
under  the  microscope,  is  seen  to  consist  of  minute  globules 
of  metallic  mercury.  The  white  residue  in  the  tube  is 
shown  to  contain  chlorin  by  dissolving  it  in  water  and 
applying  silver  nitrate. 

2.  As  a  liquid.  —  {a)  A  drop  evaporated  on  a  glass  slide 
will  yield  large,  needle-shaped,  or  prismatic  crystals.  {B) 
Solution  of  sodium  hydroxid  gives  a  yellow  precipitate  ; 
this,  when  dried  and  heated  in  a  reduction-tube,  will  yield 
sublimate  of  mercury  globules,  with  the  evolution  of  oxygen 
gas.  {c)  Ammonium  hydroxid  produces  a  white  precipitate. 
{(T)  Potassium  iodid  first  causes  a  yellow,  and  immediately 


492  TOXICOLOGY. 

afterward,  a  bright  scarlet  precipitate,  soluble  in  an  excess 
of  the  reagent.  When  this  is  dried  and  heated,  it  volatilizes, 
and  condenses  in  a  yellow  deposit,  which  gradually  changes 
to  scarlet,  (e)  Stannous  chlorid  first  throws  down  a  white 
precipitate  (calomel),  and,  if  in  excess,  a  dark  gray  precipi- 
tate (metallic  mercury),  which  runs  into  globules  on  being 
boiled.  (/)  Hydrogen  sulphid  and  ammonium  sulphid 
each  causes  a  whitish  precipitate,  soon  changing  to  red,  and 
ultimately  to  black.  (^)  A  piece  of  bright  copper  put  into 
a  cold  solution  of  corrosive  subHmate,  acidulated  with  hy- 
drochloric acid,  speedily  acquires  a  silvery-white  coating  of 
mercury.  When  the  copper  slip  is  dried  and  heated  in  a 
reduction-tube,  a  sublimate  of  globules  is  obtained,  easily 
identified  by  the  microscope.  This  test  is  extremely  deli- 
cate, and  will  detect  the  yq^^qo  °^^  grain,  if  the  copper  sur- 
face is  very  small  and  is  heated  in  a  very  small  tube. 
According  to  Wormley,  a  far  smaller  quantity  —  even  the 
5  "0  oV  0' 0^  of  a  grain  —  may  be  identified  by  employing  a  very 
small,  thin,  glass  tube,  the  one  tenth  of  an  inch  in  diameter, 
and  drawing  it  out,  by  heating,  into  a  thin  capillary  neck. 
The  small  fragment  of  coated  copper  is  introduced  through 
the  wider  portion  of  the  tube  to  the  point  of  contraction, 
and  the  wider  end  is  now  carefully  fused  shut  by  the  mouth 
blowpipe,  so  as  to  give  it  the  appearance  of  a  small  ther- 
mometer-tube, the  bulb  containing  the  coated  copper.  The 
tube  is  now  heated  at  the  bulb,  and  the  capillary  end  closed. 
On  examination  under  the  microscope,  a  well-defined  ring 
of  mercurial  globules  will  be  visible  on  the  capillary-tube, 
just  above  the  bulb. 

In  case  the  mercurial  sublimate  in  the  reduction-tube 
should  be  dim  and  unsatisfactory,  Tardieu  recommends  to 
introduce  a  minute  crystal  of  iodin  into  the  tube,  pushing 


CORROSIVE   SUBLIMATE ANALYSIS.  493 

it  down  as  far  as  the  sublimate  with  a  platinum  wire.  The 
open  end  of  the  tube  is  then  stopped  with  wax,  and  it  is 
kept  in  a  horizontal  position  for  about  twelve  hours,  at  a 
temperature  of  30°  or  40°  C,  when  the  deposit  will  assume 
a  bright  scarlet  color,  due  to  the  production  of  mercuric 
iodid.  After  removing  the  iodin,  the  tube  may  be  gently 
and  progressively  heated  from  below  by  the  flame  of  a 
spirit-lamp,  when  the  scarlet  color  will  change  to  yellow, 
and  on  cooling  the  latter  color  will  give  place  to  scarlet 
again.  {Ii)  Galvanic  Test. — This  consists  in  winding  a  strip 
of  gold  around  a  strip  of  zinc  (or  iron)  and  placing  the  coil 
in  the  acidulated  solution.  Guy  recommends  a  simpler  and 
equally  certain  method  :  To  moisten  a  narrow  slip  of  zinc 
with  water,  and  to  take  up  as  much  gold  leaf  as  will  adhere 
to  it,  and  introduce  this  into  the  acid  solution.  The  gold 
will,  in  a  short  time,  become  coated  with  a  silver-colored 
deposit  of  mercury.  It  is  then  to  be  carefully  washed  and 
dried,  and  heated  in  a  reduction-tube  when  the  usual  mer- 
curial sublimate  will  be  obtained.  The  gold  test  is  gener- 
ally regarded  as  the  most  delicate. 

Toxicologic  Examination.  —  When  the  poison  was  admin- 
istered in  the  sohd  form,  fragments  of  it  may  be  found  in 
the  stomach  yet  undissolved  ;  these  should  be  collected  and 
identified.  As  corrosive  subhmate  is  easily  acted  on  by 
albumin,  glutin,  and  other  substances,  much  of  it  may  be 
changed  into  insoluble  compounds.  If  the  dose  taken  be 
small  and  in  the  liquid  form,  it  may  escape  discovery  in  the 
contents  of  the  stomach.  If  the  quantity  in  solution  is  con- 
siderable, it  may  be  extracted  by  simply  agitating  it  with 
twice  its  volume  of  ether,  and,  after  it  has  settled,  removing 
the  ether  by  means  of  a  pipette,  and  allowing  it  to  evaporate 
spontaneously,  when  the  salt  will  crystallize  in  white,  silky 


494  TOXICOLOGY. 

prisms.  These  may  be  purified,  if  necessary,  by  dissolving 
in  water  or  alcohol,  and  again  crystallizing.  This  method 
has  the  advantage  of  recovering  the  poison  in  the  exact  state 
in  which  it  was  swallowed,  without  the  reservation,  however, 
that  ether  might  act  upon  any  mercurial  salt  in  the  presence 
of  a  chlorid  —  e.  g.,  sodium  chlorid  —  similarly. 

The  stomach  and  its  contents  should  be  prepared  in  the 
usual  manner,  already  described,  and  heated  with  distilled 
water  and  hydrochloric  acid.  After  proper  filtration  and 
concentration,  a  trial  test  may  be  made  with  a  strip  of  cop- 
per, allowing  this  to  remain  in  the  solution,  if  necessary,  for 
several  hours.  The  gold  test  may  be  applied  in  a  similar 
manner.  By  either  of  these  processes  the  metal  can  be 
recovered  in  a  satisfactory  manner.  The  other  tests  above 
mentioned  may  also  be  applied  as  corroborative  proofs. 

The  solid  matters  remaining,  after  straining  off  the  fluid, 
will  probably  contain  much  of  the  poison  combined  with 
organic  substances.  These  should  be  boiled  in  distilled 
water,  with  hydrochloric  acid,  until  disintegrated,  then 
filtered  and  concentrated,  and  tested  as  above.  Another 
method  is  to  dry  the  solid  matters  thoroughly,  and  digest 
them  in  warm  nitro-hydrochloric  acid,  by  which  the  insolu- 
ble mass  is  converted  into  soluble  corrosive  sublimate.  The 
acid  liquid  is  then  evaporated  to  diyness,  the  residue  dis- 
solved in  water  and  filtered,  and  the  usual  tests  applied ;  or 
the  corrosive  sublimate  is  dissolved  out  by  ether. 

In  the  tissues.  —  The  liver,  or  other  organs,  should  first 
be  crushed  in  a  mortar,  with  sufficient  alcohol  to  render 
filtration  easy.  Acidulate  the  mass  with  hydrochloric  acid, 
and  gently  warm  for  some  time  ;  then  filter  through  paper, 
and  apply  the  copper,  or  the  galvanic,  test,  and  hydrogen 
sulphid  to  the  filtrate.     All  the  solid  portions  are  now  to  be 


TOXICOLOGICAL    EXAMINATION    FOR    MERCURY.  495 

mixed  with  water  and  four  parts  of  hydrochloric  acid,  and 
boiled  for  some  time  ;  when  cool,  they  are  to  be  filtered  and 
the  filtrate  examined  as  above. 

Should  arsenic  happen  to  be  present  in  the  tissues  along 
with  corrosive  sublimate,  on  the  application  of  Reinsch's 
test  both  metals  will  be  precipitated  on  the  copper,  and 
both  will  sublime  from  the  latter  when  it  is  heated  in  the 
reduction-tube  ;  but  in  the  cold,  mercury  alone  will  be 
deposited  on  the  copper. 

To  detect  mercury  in  the  saliva,  acidulate  about  two 
drachms  of  this  fluid  with  one  fourth  of  hydrochloric  acid, 
and  introduce  into  the  mixture  a  small  piece  of  bright 
copper  foil,  and  heat  gently  for  several  hours.  The  gold 
test  may  also  be  used.  The  silvery  deposit  will  indicate  the 
presence  of  mercury,  which  will  be  confirmed  by  heating  it, 
when  washed  and  dried,  in  a  reduction -tube,  and  procuring 
the  characteristic  mercurial  globules  by  sublimation. 

In  examining  the  urine,  evaporate  about  twelve  or  four- 
teen ounces  down  to  one  ounce  ;  acidulate  this  with  hydro- 
chloric acid  ;  filter  and  boil  the  filtrate,  and  introduce  a 
fragment  of  bright  copper,  and  confirm  as  directed  above. 

It  should  be  remembered  that  death  may  ensue  from 
corrosive  sublimate  and  no  mercury  be  found  in  the  tissues, 
as  where  the  person  has  survived  for  a  number  of  days. 
Also,  as  in  the  case  of  other  poisons,  there  may  be  a  failure 
to  detect  it  in  the  stomach  after  death,  even  when  large 
doses  had  been  swallowed. 

On  the  other  hand,  the  detection  of  minute  quantities  of 
mercury  in  the  organs  is  not  always  evidence  of  poisoning, 
inasmuch  as  the  person  may  have  lately  taken  blue  pill  or 
calomel  as  a  medicine  ;  hence,  caution  should  be  exercised 
in  reference  to  this  point. 


496  TOXICOLOGY. 

Corrosive  sublimate  is  usually  estimated  quantitatively 
as  sulphid  by  carefully  washing  and  drying  the  precipitate 
obtained  by  hydrogen  sulphid.  Every  100  grains  of  dry 
sulphid  are  equivalent  to  116.8  grains  of  corrosive  sub- 
limate. Sometimes  stannous  chlorid  is  used  to  precipitate 
mercury  from  solution.  The  globules  should  first  be  puri- 
fied by  boiling  them  in  a  solution  of  sodium  hydroxid,  and 
afterward  in  hydrochloric  acid.  Every  100  grains  of  mer- 
cuiy  represent  135.5  grains  of  corrosive  sublimate. 

Mercuric  lodid.  —  R.  Brummitt  reports  the  following 
case.  A  woman  took  some  tablets  of  mercuric  iodid  con- 
taining in  all  about  one  fourth  of  a  grain  of  the  drug.  She 
was  soon  seized  with  severe  abdominal  pain,  and  later  fell 
unconscious  to  the  floor.  The  physician  found  her  lying 
flat  on  the  face  with  extended  arms  and  marked  muscular 
rigidity,  seeming,  indeed,  to  be  dead.  The  countenance 
was  dusky,  the  eyes  closed,  conjunctiva  insensitive,  pupils 
dilated  and  the  radial  pulse  imperceptible.  A  careful 
examination  showed  a  cardiac  movement  and  feeble  respira- 
tion. A  change  of  position  was  followed  by  improvement 
in  respiration  and  heart-action.  There  were  no  signs  of 
corrosion  about  the  mouth  or  of  vomiting.  One  tenth  of  a 
grain  of  apomorphin  was  given  hypodermically,  which 
caused  vomiting  of  dark,  partially-digested  food.  The 
stomach  was  washed  out  and  white  of  &gg  adminis- 
tered. In  three  hours  the  patient  was  considered  out  of 
danger,  but  complained  of  soreness  of  the  throat  and  some 
burning  pain  in  the  stomach.  During  the  night  there  were 
numerous  movements  of  the  bowels.  It  may  be  that  this 
patient  was  especially  susceptible  to  the  poison. 

Other  compounds  of  mercury  may  occasionally  prove 
poisonous,  as  the  mercuric  oxid,  mercuric  nitrate,  and  mer- 


POISONING    BY    LEAD.  497 

curie  sulphate.     The  treatment,  and  analytic  investigations 
in  such  cases  are  essentially  the  same  as  indicated  above. 

LEAD  COMPOUNDS. 

In  the  free  state,  Lead  is  not  considered  poisonous, 
except  when  freely  divided,  when  it  will  be  dissolved  in  the 
stomach.  All  its  salts  are  poisonous  ;  with  perhaps  the 
single  exception  of  the  sulphate,  which  is  very  insoluble. 

Acute  poisoning  by  lead  compounds  is  rare,  except  as 
the  result  of  accident.  On  the  other  hand,  chronic  or  slow 
lead-poisoning  is  of  frequent  occurrence,  since  there  is  no 
element  more  constantly  and  insidiously  introduced  into  the 
human  system  than  lead  under  its  varied  forms.  In  the 
arts,  the  workmen  in  this  metal  inhale  the  fumes  and 
powders  in  smelting  the  ores  and  manufacturing  white  lead. 
Painters,  plumbers,  pewterers,  and  glazers  of  pottery  are 
all  exposed  to  similar  danger.  Sleeping  in  a  freshly-painted 
room  has  been  assigned  as  a  cause  of  an  attack  of  colic  and 
paralysis,  but  these  effects  were  probably  due  to  emanations 
from  the  turpentine  or  benzin. 

The  frequent  handling  of  pewter  vessels,  and  especially 
of  new  type,  has  produced  lead  palsy.  The  use  of  glazed 
pottery  is  another  source  of  contamination,  arising  from  the 
action  of  acids,  such  as  vinegar,  and  of  oils  and  fats ;  also 
of  alkalies  on  the  glaze,  which  consists  largely  of  litharge 
(lead  monoxid).  Even  milk  has  become  poisonous  in  this 
way.  Cider  and  beer,  drawn  through  leaden  pipes,  may 
become  contaminated  in  the  same  manner.  Wine  may  be- 
come affected  by  contact  with  the  shot  left  in  the  bottles 
through  carelessness.  New  rum  is  apt  to  contain  lead,  de- 
rived from  the  leaden  worm  of  the  still,  while  old  rum  is 
free  from  this  adulteration.  This  is  ascribed,  with  great 
42 


49^  TOXICOLOGY. 

probability,  to  the  fact  that  old  rum,  being  kept  in  oak 
casks,  is  deprived  of  its  lead  by  the  tannin  of  the  cask. 

Certain  medicinal  substances  often  contain  small  amounts 
of  lead,  derived  from  the  mode  of  their  manufacture.  Alka- 
line solutions,  when  kept  in  flint-glass  bottles,  soon  become 
impregnated  with  lead.  Commercial  sulphuric  acid  almost 
invariably  contains  lead  derived  from  the  leaden  vessels  in 
which  it  is  prepared. 

Many  articles  in  domestic  use  are  not  infrequently  con- 
taminated by  lead,  as  flour  (from  the  plugs  of  lead  imbedded 
in  the  millstones),  sugar,  snuff,  tobacco,  chocolate,  and  bon- 
bons—  the  latter  articles  from  the  impure  tin-foil  wrappers. 
Numerous  cases  of  lead-poisoning  have  been  traced  to  the 
use  of  chrome  yellow  (lead  chromate),  as  a  substitute  for 
eggs  in  making  buns  and  noodles.  Canned  goods  often 
contain  lead ;  even  when  put  up  in  glass  cans  lead  may  be 
dissolved  from  the  rubber  washers,  containing  lead  carbon- 
ate, placed  under  the  cover. 

The  external  application  of  the  preparations  of  lead  is 
often  the  cause  of  slow  poisoning,  as  in  handling  the  metal, 
already  alluded  to ;  the  use  of  hair-dyes  and  cosmetics ; 
and  even  from  the  glazed  lining  of  hats.  The  direct  appli- 
cation of  white  lead  to  the  scalded  surface,  as  a  dressing, 
has  been  known  to  produce  symptoms  of  lead  colic. 

Probably  the  most  frequent  source  of  chronic  lead-poi- 
soning is  through  drinking-water  which  has,  in  some  way 
or  other,  been  in  previous  contact  with  metallic  lead.  The 
conditions  under  which  this  occurs  are  not  fully  understood. 
Rain-water,  which  is  frequently  preserved  in  cisterns  for 
drinking  purposes,  should  never  be  collected  from  a  leaden 
roof,  nor  be  conducted  through  leaden  pipes,  nor  in  any  way 
come  in  contact  with  this  metal.     On  the  other  hand,  most 


LEAD  ACETATE ACUTE  POISONING.        499 

river  and  spring  water,  which  always  contain  more  or  less  of 
saline  ingredients,  generally  exert  little  deleterious  influence 
upon  lead,  in  consequence  of  the  action  of  some  of  the  salts 
existing  in  the  water ;  these  form  an  insoluble  film  or  coat- 
ing upon  the  surface  of  the  lead,  thus  preserving  it  from  any 
further  action  of  the  water.  Free  acids  in  the  water  very 
much  increase  the  danger  of  contamination. 

Another  cause  of  contamination  may  arise  from  a  galvanic 
action  between  lead'  and  other  metals  together,  especially 
when  in  contact  with  water  containing  carbonic  acid. 
Danger  also  arises  from  a  leaden  cover  being  over  a  pump 
or  cistern.  The  vapor  of  the  water  (which  is  equivalent 
to  distilled  water),  impinging  on  the  metal  surface,  dis- 
solves off  the  oxid  and  carbonate,  which  may  in  time  fall 
into  and  contaminate  the  water. 

The  compounds  of  lead  of  toxicologic  interest  are  the 
acetate,  carbonate  and  chromate. 

Lead  Acetate  {Sugar  of  Lead)  occurs  in  commerce  in 
masses  of  white  or  light  brownish  crystals,  somewhat  re- 
sembhng  loaf  sugar  in  appearance.  It  has  an  acetous  odor, 
and  a  sweetish,  astringent  taste.  It  is  soluble  in  water  ;  less 
so  in  alcohol.  Its  aqueous  solution  is  often  turbid  from  the 
presence  of  carbonate. 

It  is  not  a  very  active  poison.  It  is  much  used  in  med- 
ical practice,  but  its  continued  employment  has  occasionally 
resulted  in  bringing  on  symptoms  of  lead-poisoning. 

In  doses  of  an  ounce  or  two  it  acts  as  a  powerful  irritant, 
causing  burning  pains  in  the  throat  and  stomach,  and  thirst, 
vomiting,  twisting,  coHcky  pains,  with  tenderness  in  the 
abdomen,  obstinate  constipation,  retraction  of  the  abdominal 
walls,  anxious  countenance,  cold  sweats,  and  convulsions. 


500  TOXICOLOGY. 

The  urine  is  diminished  in  quantity.  In  protracted  cases 
there  is  often  paralysis  of  one  or  more  of  the  extremities. 
Its  influence  on  the  nerve  centers  is  marked  by  giddiness, 
stupor,  convulsions,  and  coma.  In  some  cases  there  is 
purging  of  bloody  matters,  though  usually  the  fecal  dis- 
charges are  hard,  dry,  and  black.  The  peculiar  blue  line 
upon  the  edge  of  the  gums,  characteristic  of  chronic  lead- 
poisoning,  may  sometimes  be  observed  in  acute  cases. 

The  fatal  quantity  is  uncertain  ;  an  ounce  has  been  swal- 
lowed with  impunity,  though  a  less  quantity  has  occasioned 
alarming  symptoms.  The  fatal  period  is  equally  uncertain, 
varying  from  a  few  hours  to  several  days. 

The  proper  antidotes  are  soluble  sulphates,  especially  mag- 
nesium sulphate,  which  forms  insoluble  lead  sulphate.  At 
first,  however,  vomiting  should  be  promoted  by  zinc  sulphate; 
afterward  opium  and  castor  oil  may  be  required.  The  urine 
should  be  frequently  examined  for  the  presence  of  lead. 

Post-mortem  Appearances.  —  Often  no  well-marked  lesions 
are  discoverable.  Sometimes  there  is  inflammation  of  the 
alimentary  tract.  Sometimes  the  inner  coat  of  the  stomach 
and  bowels  is  covered  with  a  thick,  whitish  layer  of  mucus 
mixed  with  the  poison,  beneath  which  the  membrane  is 
reddened,  or  even  abraded.  The  intestines  are  generally 
found  contracted. 

Chronic  Poisoning. — This  may  result  from  the  continued 
internal  use  of  any  lead  compound ;  but  it  is  more  fre- 
quently produced  among  artisans  working  in  white  lead 
and  litharge,  or  by  the  accidental  introduction  of  the  metal 
into  the  system  through  drinking-water  or  articles  of  food. 

The  earlier  symptoms  are  grouped  under  the  names  of 
Lead  Colic,  Painter's  Colic,  or  Colica  Pictomun ;  the  latter 
symptoms  are  named  Lead  Palsy. 


POISONING    BY   LEAD LEAD    PALSY.  50I 

Lead  Colic.  —  The  earlier  symptoms  are  obstinate  consti- 
pation and  indigestion,  with  great  depression.  Then  there 
is  a  feeling  of  twisting,  grinding  pain  about  the  umbilicus, 
which  may  be  rather  relieved  by  pressure.  The  abdomen 
is  hard  and  retracted  ;  sometimes  there  are  scanty,  hard 
evacuations,  with  much  suffering.  The  urine  is  scanty 
and  voided  with  difficulty.  The  countenance  is  dull  and 
anxious ;  skin  cold  and  clammy ;  pulse  about  natural ; 
respiration  quick  and  catching  ;  loss  of  appetite,  with  dry- 
ness of  the  mouth  and  throat ;  the  breath  is  fetid,  and  there 
is  often  a  metallic  taste  in  the  mouth.  A  characteristic  sign 
of  saturnine  poisoning  is  the  blue  line  at  the  margin  of  the 
gums,  where  they  join  the  teeth,  especially  noticeable  on 
the  incisors.  This  is  probably  due  to  the  deposition  of 
lead  sulphid  in  the  capillaries  of  the  gums,  as  can  be  shown 
by  the  microscope.  Silver  and  mercury  compounds  occa- 
sionally produce  a  somiewhat  similar  blue  line,  and  it  is 
wanting  in  some  cases  of  chronic  lead-poisoning.  When 
once  established,  the  condition  is  very  persistent. 

Lead  Palsy.  —  Lead  colic,  if  allowed  to  continue  un- 
checked, is  very  apt  to  terminate  in  paralysis,  especially 
after  repeated  attacks  of  the  former.  Again,  it  may  come 
on  without  any  previous  attack  of  colic.  It  usually  affects 
the  upper  extremities.  At  first  there  is  a  dull,  numb  feel- 
ing in  the  skin  of  the  fingers  and  forearms,  trembling  of  the 
arms  and  legs,  unsteadiness  of  gait,  loss  of  power  in  the 
hands  and  arms,  which  gradually  waste  away.  The  ex- 
tensors are  more  affected  than  the  flexors^^so  that  when 
the  arm  is  raised  the  hand  drops  by^its  own  weight,  whence 
the  common  name  of  "  wrist-drop  "  for  this  disease.  If 
unchecked,  brain  symptoms  present  themselves,  such  as 
giddiness,  torpor,  and  apoplexy ;  sometimes  there  are  epi- 


502  TOXICOLOGY, 

leptic  fits,  edema,  albuminuria,  and  convulsions,  ending  in 
coma  and  death. 

Lead  has  been  found,  after  death,  in  the  brain,  and  espe- 
cially in  the  gray  matter  of  the  spinal  cord ;  also  in  the 
bones,  liver,  and  kidneys.  Doubtless,  many  cases  of  ob- 
scure spinal,  cerebral,  and  cardiac  disease  are  really  owing 
to  chronic  lead-poisoning  —  the  element  having  been  intro- 
duced unsuspectedly  into  the  system. 

Sabrazes  and  Bourret  made  observations  on  the  condi- 
tions of  the  blood  in  a  case  of  attempted  suicide  with  lead 
acetate  solution  in  which  a  small  amount  of  arsenic  was 
present.  They  consider  the  quantity  of  arsenic  too  small  to 
be  taken  into  consideration.  The  greater  part  of  the  poison 
was  thrown  out  by  prompt  vomiting  ;  antidotes  were  also 
used.  Nevertheless,  symptoms  of  lead-poisoning  devel- 
oped, including  discoloration  of  the  gums,  colic  and  head- 
ache. The  blood  showed  normoblasts,  basophilic,  granular 
and  polychromatic  cells,  also  neutrophilic,  polymorphonu- 
cleated  leukocytes.  These  phenomena  appeared  on  the 
second  day,  coincidently  with  the  aggravation  of  the  gen- 
eral symptoms,  and  declined  as  these  declined,  except  that 
an  intercurrent  attack  of  measles  increased  the  polymor- 
phonucleated  cells.  The  authors  state  that  the  use  of 
arsenic  does  not  give  rise  to  such  conditions.  Blood  ex- 
aminations may,  therefore,  be  of  value  in  suspected  cases 
of  lead-poisoning. 

Analytic  Methods.  —  I.  In  the  Solid  State.  —  Lead  acetate 
heated  in  a  test-tube  evolves  an  acetous  odor,  and  fuses  into 
a  white  mass  ;  if  the  heat  is  continued,  it  again  fuses  and 
slowly  chars,  and  is  converted  into  a  reddish-brown  mixture 
of  the  oxids  of  lead.  Heated  on  charcoal,  before  the  blow- 
pipe, it  yields  globules  of  lead,  with  a  surrounding  incrus- 


LEAD TOXICOLOGIC     EXAMINATION.  503 

tation  of  yellow  oxid.  A  fragment  dropped  into  a  solution 
of  potassium  iodid  instantly  turns  yellow  ;  touched  with 
ammonium  sulphid,  it  immediately  is  blackened. 

II.  In  the  Liquid  State.  —  (i)  A  drop  evaporated  on  glass 
yields  opaque  needles,  which  turn  yellow  when  touched 
with  a  drop  of  potassium  iodid  solution  or  solution  of 
potassium  dichromate ;  or  black,  by  ammonium  sulphid. 
(2)  Dilute  sulphuric  acid  causes  a  white  precipitate,  soluble 
in  hot  hydrochloric  acid  and  in  large  excess  of  sodium  hy- 
droxid.  (3)  Potassium  iodid  gives  a  bright  yellow  pre- 
cipitate, soluble  in  boiling  water,  which  deposits  it  in  brilliant 
yellow  hexagonal  scales  on  cooling.  This  crystalline  form, 
which  is  seen  under  moderate  magnifying  power,  is  highly 
characteristic.  (4)  Potassium  dichromate  gives  a  bright 
yellow  precipitate.  (5)  Hydrogen  sulphid  is  a  delicate  test. 
The  black  sulphid  is  confirmed  by  heating  it  on  charcoal, 
before  the  blowpipe  ;  or  by  dissolving  it  in  nitric  acid,  by 
the  aid  of  heat,  evaporating  to  dryness,  dissolving  in  water, 
and  applying  the  usual  tests.  (6)  A  drop  or  two  of  the 
solution,  slightly  acidified  with  acetic  acid,  is  put  into  a 
platinum  capsule,  and  a  strip  of  zinc  is  made  to  touch  the 
platinum  through  the  liquid  ;  crystals  of  metallic  lead  are 
deposited  on  the  zinc  ;  or  a  fragment  of  zinc  may  be  placed 
in  the  lead  solution  in  a  watch  glass,  when  very  soon 
metaiHc  lead  will  be  deposited  upon  the  zinc  in  an  arbores- 
cent form.  A  salt  of  tin,  under  similar  circumstances, 
would  yield  an  arborescent  deposit  of  tin.  Hence,  the 
deposit  must  be  further  tested  by  dissolving  it  in  nitric  acid 
and  applying  the  usual  tests. 

Toxicologic  Exmnination.  —  As  lead  acetate  is  easily  pre- 
cipitated by  many  organic  substances,  such  as  albumin, 
casein,  mucus,  etc.,  the  poison  may  exist  both  in  the  soluble 


504  TOXICOLOGY. 

and  insoluble  conditions.  As  a  trial  test,  a  good  plan  is  to 
wet  a  piece  of  bibulous  paper  in  the  suspected  solution  and 
expose  it  to  a  jet  of  hydrogen  sulpbjd  gas,  which  will  blacken 
it  if  it  contains  any  lead.  If  the  presence  of  the  element 
be  indicated,  the  mixture  should  be  acidulated  with  pure 
nitric  acid  and  boiled  for  some  time ;  when  cold,  it  should 
be  filtered,  and  the  solids  on  the  filter  thoroughly  washed 
and  reserved  for  future  examination.  Concentrate  the  fil- 
trate by  evaporation  and  treat  with  hydrogen  sulphid  ;  allow 
the  precipitated  sulphid  of  lead  to  collect,  pour  off  the  super- 
natant water,  boil  in  dilute  nitric  acid,  add  sufficient  distilled 
water,  and  apply  the  usual  tests. 

The  solids  on  the  filter  should  be  dried  and  incinerated 
in  a  porcelain  capsule ;  dissolve  the  ash  by  heat  in  dilute 
nitric  acid,  filter,  and  treat  with  hydrogen  sulphid,  and  prove 
the  precipitated  sulphid. 

If  a  sulphate  has  been  given  as  antidote,  a  white  pre- 
cipitate of  lead  sulphate  may  be  found  in  the  stomach. 
This  should  be  collected  and  boiled  with  potassium  hydroxid 
(previously  tested  to  insure  its  freedom  from  lead)  and  the 
solution  tested  with  hydrogen  sulphid,  or  it  may  be  boiled 
with  ammonium  carbonate,  and  the  resulting  lead  carbonate 
decomposed  by  acetic  acid. 

The  solid  organs  (liver,  spleen,  etc.)  may  be  examined 
either  by  boiling  with  nitric  acid  and  water,  evaporating  to 
dryness,  incinerating  in  a  porcelain  crucible,  and  again  dis- 
solving by  heat  and  dilute  nitric  acid  ;  or  by  directly  incin- 
erating them  in  a  porcelain  crucible,  and  dissolving  out  the 
lead  with  strong  nitric  acid,  evaporating  to  diyness,  diluting 
with  water,  and  precipitating  with  hydrogen  sulphid. 

Since  organic  matters  retain  lead  with  great  tenacity,  the 
substances    should  not    only  be  carbonized,  but    brought 


POISONING    BY    LEAD    CHROMATE,  505 

completely  to  an  ash.  Boucher  has  shown  that  the  carbon 
retains  lead  residue,  which  resists,  to  a  considerable  extent, 
the  action  of  solvents.  This  was  verified  in  some  examina- 
tions made  by  Drs.  Reese  and  Leffmann. 

As  regards  the  localization  of  lead  in  the  different  organs, 
this  metal  seems  to  be  eliminated  from  the  system  largely 
through  the  liver  and  kidneys.  That  which  is  eliminated 
by  the  liver  is  found  in  the  feces,  which  have  lately  been 
shown  to  contain  a  considerable  proportion  of  the  total  lead 
eliminated.  It  is  found  in  the  brain  and  spinal  cord,  but  in 
smaller  quantities  than  in  the  above-mentioned  organs. 

Since  lead  remains  in  the  system  for  a  considerable  time, 
inquiry  should  always  be  instituted  in  case  of  the  detection 
of  only  a  minute  quantity,  in  reference  to  the  possibility  of 
its  accidental  introduction  into  the  system  through  the 
occupation,  mode  of  living,  etc.,  of  the  individual. 

The  examination  of  the  urine  should  never  be  neglected, 
since  lead  is  eliminated  from  the  system  often  through 
this  secretion.  From  fifteen  to  twenty  ounces  of  urine, 
acidulated  with  nitric  acid,  should  be  evaporated  to  dryness, 
incinerated  as  above  directed,  and  the  ash  treated  as  already 
described. 

For  the  detection  of  lead  in  sweetmeats,  slightly  moisten 
them  with  water  and  put  them  on  a  plate,  placing  in  the 
center  a  little  capsule  containing  about  a  drachm  of  ammo- 
nium sulphid,  and  cover  the  whole  with  a  tumbler.  If  lead 
be  present  the  sweetmeats  will,  after  a  short  time,  be 
blackened  by  hydrogen  sulphid  evolved. 

Lesid  Chromate  {C/irome  Yellovo).  —  Commercial  chrome 
yellow  often  contains  considerable  lead  carbonate  and  some 
lead  hydroxid,  which,  being  more  soluble  in  the  gastric  juice, 


5o6  TOXICOLOGY. 

doubtless  increase  the  activity  of  the  drug.  It  has  been 
much  employed,  not  only  as  a  pigment,  but  also  exten- 
sively to  impart  a  yellow  color  to  confections  and  buns. 
In  the  latter  case  it  is  used  as  a  cheap  substitute  for  eggs, 
in  order  to  give  the  desired  rich  yellow  tint.  Within  the 
past  few  years  a  considerable  number  of  cases  of  chronic 
lead-poisoning,  from  the  use  of  buns  colored  with  this 
salt,  occurred  in  Philadelphia,  many  of  which  proved  fatal. 
To  Dr.  David  D.  Stewart  is  due  the  credit  of  having  detected 
this  important  fact.  He  diagnosed  lead-poisoning  in  cases 
in  which  investigation  had  been  made  by  other  physicians 
without  result,  and,  finally,  after  much  inquiry,  traced  the 
source  of  poisonings  to  certain  bakers.  Most  of  the  cases 
exhibited  the  usual  marked  symptoms  of  chronic  lead-poison- 
ing, although  some,  especially  the  fatal  ones,  suffered  from 
more  pronounced  eclamptic  symptoms  than  is  usual.  Drs. 
Reese  and  Leffmann  made  a  toxicologic  examination  of 
portions  of  the  bodies  of  five  of  the  fatal  cases,  at  different 
periods  after  death,  varying  from  one  week  up  to  two  years. 
In  every  instance  positive  evidence  of  the  presence  of  lead 
was  afforded :  in  one  body,  in  the  spinal  cord ;  in  four 
bodies,  in  the  liver ;  in  two  cases,  in  the  kidney  ;  in  one 
case,  five  months  after  death,  in  the  brain. 

Chromium  was  not  sought  for  in  the  above  examinations. 

Lead  is  quantitatively  determined  as  a  sulphid.  Every 
lOO  parts  of  dry  sulphid  represent  93.31  parts  of  the  oxid, 
or  158.37  parts  of  crystallized  acetate. 

COPPER  COMPOUNDS. 
Copper  is  not  actively  poisonous  in  its  free  state,  but  may 
dissolve  in  the   stomach  and  produce  marked  symptoms. 
Copper    coins    swallowed    may    thus    produce    dangerous 


POISONING    BY    COPPER.  $0/ 

results.  The  inhalation  of  copper  alloy  in  fine  powder  by- 
artisans  who  work  in  so-called  gold  printing,  causes  serious 
results,  such  as  constriction  and  heat  of  throat,  vomiting, 
loss  of  appetite,  and  severe  itching  of  the  parts  of  the  body 
covered  with  hair,  which,  on  examination,  are  found  to  be 
of  a  deep  green  color. 

Cases  of  accidental  copper-poisoning  can  sometimes  be 
traced  to  want  of  cleanliness  in  cooking,  or  to  keeping  food 
in  copper  vessels,  particularly  such  food  as  contains  a  vege- 
table acid,  vinegar,  common  salt,  or  any  kind  of  oil  or  fat. 
So  long  as  copper  utensils  are  kept  perfectly  clean  and 
bright,  little  risk  is  incurred  in  using  them  ;  but  if  cleanli- 
ness be  neglected,  a  poisonous  deposit  collects,  which  will 
contaminate  any  food  with  which  it  may  come  in  contact. 
There  is  no  risk  in  boiling  articles  of  food  or  preserves  in 
clean  copper  vessels,  although  it  is  unsafe  to  keep  these 
articles,  cold,  in  the  same  vessels  ;  in  the  latter  case,  the 
atmospheric  air  acts  upon  the  metal  at  the  point  of  contact 
of  the  contained  substance.  Dr.  Falconer  gives  an  instruc- 
tive example  of  this.  A  servant  left  some  sauer-kraut,  for 
only  a  couple  of  hours,  in  a  copper  pan  which  had  lost  its 
tinning.  Her  mistress  and  daughter,  who  ate  of  the  cab- 
bage, died  after  twelve  hours'  sickness.  Wildberg  found 
the  cabbage  so  strongly  impregnated  with  copper  that  it 
was  detected  with  metallic  iron.  There  is  risk  in  the  use 
of  copper  boilers.  In  one  case  3.5  grains  to  the  gallon  were 
found  in  water  drawn  from  a  kitchen  boiler. 

The  inference  from  the  above  facts  would  be  that  it  is 
somewhat  unsafe  to  employ  copper  vessels  either  for  cook- 
ing, or,  still  more  so,  for  preserving  articles  of  food.  Even 
tinned  copper  vessels  are  not  always  safe,  because  the  tinning 
may  consist  of  an  alloy  of  tin  and  lead,  and  the  latter  might, 
in  its  turn,  prove  a  source  of  danger. 


508  TOXICOLOGY. 

The  alloy  termed  Dutch-metal,  used  for  ornamenting 
cakes  and  confectionery  as  a  substitute  for  gold  leaf,  may 
also  prove  a  source  of  poisoning ;  likewise  the  blue  and 
green  papers  used  as  wrappers  for  bon-bons,  although  the 
chief  source  of  danger  from  the  latter  arises  from  the  arsenic 
contained  in  their  composition. 

The  fine  green  color  of  many  samples  of  pickles,  peas, 
and  preserved  fruits  is  often  due  to  the  addition  of  a  copper 
compound,  as  verdigris  or  blue  vitriol.  This  may  be  easily 
detected  by  placing  the  suspected  article  in  ammonium 
hydroxid,  when,  if  copper  be  present,  it  will  turn  blue. 
Another  method  is  to  plunge  a  bright  needle  into  the  article  ; 
if  copper  be  present,  it  will  speedily  receive  a  reddish  coat- 
ing of  the  metal. 

All  copper  salts  are  poisonous  ;  those  of  most  importance 
are  the  sulphate  (blue  vitriol,  blue  stone),  and  the  subacetate 
(verdigris).  The  arsenite  and  aceto-arsenite  have  already 
been  described  under  the  head  of  Arsenic,  A  copper  car- 
bonate produced  by  the  action  of  moist  air  on  the  metal,  or 
on  brass,  is  sometimes  called  verdigris. 

The  salts  of  copper  are  rarely  used  for  homicidal  poison- 
ing, as  they  can  be  so  readily  recognized  both  by  their  color 
and  taste.  Occasionally  they  have  been  taken  suicidally, 
and  more  rarely  by  accident.  The  sulphate  has  been  em- 
ployed for  producing  abortion. 

Symptoms.  —  The  sulphate  may  be  taken  as  a  type  of  all 
the  salts.  In  large  doses  it  speedily  produces  active  vomit- 
ing, which  usually  expels  much  of  the  poison.  There  are 
pains  in  the  stomach  and  bowels,  great  thirst,  purging, 
headache,  prostration,  small,  frequent  pulse,  with  increased 
flow  of  saliva.  The  matters  vomited  are  bluish  or  greenish  ; 
those  from  the  bowels  are  greenish,  and  tinged  with  blood. 


POISONING    BY    COPPER.  5O9 

Sometimes  there  are  severe  cramps  and  convulsions.  There 
is  also  suppression  of  urine,  and,  in  fatal  cases,  paralysis  and 
tetanus  have  preceded  death.  Jaundice  is  also  an  occa- 
sional result.  Dr.  Tidy  speaks  of  it  as  "  the  specially  diag- 
nostic symptom  of  copper-poisoning."  It  is  not  met  with 
in  poisoning  by  either  arsenic  or  mercury  compounds. 

The  symptoms  of  slow  poisoning  (which  is  generally  the 
result  of  the  accidental  introduction  in  articles  of  food)  are 
an  acrid,  styptic,  coppery  taste  in  the  mouth,  dry  and 
parched  tongue,  coppeiy  eructations,  continual  spitting, 
nausea  and  vomiting,  colicky  pains  in  the  bowels,  diarrhea 
of  bloody  stools,  with  tenesmus,  great  thirst,  heat  of  skin, 
small  and  tense  pulse,  scanty  urine,  headache,  vertigo, 
faintness,  cramps  of  the  legs  and  convulsions  ;  occasionally 
jaundice  and  a  blue  line  on  the  margin  of  the  gums. 

Fatal  Dose.  —  Not  positively  determined.  Half  an  ounce 
of  verdigris  has  proved  fatal,  and  an  ounce  of  the  sulphate  ; 
but  larger  quantities  have  been  swallowed  without  produc- 
ing death.  The  usual  emetic  dose  is  five  to  fifteen  grains. 
The  usual  fatal  period  is  from  four  to  twelve  hours. 

Treatment.  —  Free  vomiting  should  be  assisted  by  the 
use  of  warm  diluent  drinks.  The  best  antidote  is  albumin 
in  the  form  of  white  of  eggs,  as  for  corrosive  sublimate. 
Milk  is  also  very  useful. 

Morbid  Appearances.  —  These  indicate  the  action  of  a 
powerful  irritant  to  the  mucous  membrane  of  the  alimen- 
tary canal,  from  the  throat  downward.  The  lining  mem- 
brane of  the  stomach  is  inflamed,  softened,  and  sometimes 
ulcerated.  It  usually  exhibits  a  bluish  or  greenish  appear- 
ance, due  to  the  color  of  the  salt  taken.  The  same  is  true, 
also,  of  the  intestines.  As  a  somewhat  similar  appearance 
may  result  from  the  appearance  of  bile,  it  is  proper  to  dis- 


510  TOXICOLOGY. 

tinguish  between  them  by  the  addition  of  ammonium  hy- 
droxid,  which  will  impart  a  deep  blue  color  if  copper  is 
present,  but  will  cause  no  change  in  the  green  color  if  due 
to  bile.  Perforations  have  been  found  in  the  small  intes- 
tines ;  the  rectum  is  occasionally  ulcerated,  and  the  lungs 
congested. 

Analytic  Methods. — All  the  salts  of  common  copper 
possess  either  a  blue  or  green  color.  A  few  other  salts  are 
thus  colored,  as  some  of  the  cobalt  salts,  blue,  and  some  of 
those  of  nickel,  chromium,  and  uranium,  green.  When 
heated  in  the  blowpipe  flame  they  impart  to  it  a  beautiful 
green  color ;  and  when  heated  on  charcoal,  with  diy 
sodium  carbonate,  before  the  blowpipe,  globules  of  copper 
are  obtained. 

Copper  Sulphate,  blue  vitriol,  occurs  in  large  crystals, 
soluble  in  water;  the  solution  has  a  nauseous,  styptic,, 
metallic  taste.  The  verdigris  of  commerce  occurs  in  masses 
of  a  Hght  green  or  bluish -green  color.  It  is  soluble  in 
water  and  in  dilute  acids. 

1.  Ammonium  hydroxid  produces  a  bluish  precipitate 
which  is  redissolved  by  an  excess  of  the  precipitant,  yield- 
ing a  beautiful,  clear,  dark,  purple-blue  solution ;  this  color 
is  immediately  removed  by  an  acid.  The  salts  of  cobalt, 
nickel,  and  chromium  give  somewhat  similar  results. 

2.  Potassium  ferrocyanid  gives  a  reddish-brown  precipi- 
tate, insoluble  in  excess  of  the  reagent,  but  soluble  in  am- 
monium hydroxid.  If  the  copper  solution  be  very  dilute, 
no  precipitate  may  take  place,  but  only  the  distinct  brown- 
ish-red discoloration. 

3.  Hydrogen  sulphid,  or  ammonium  sulphid,  yields  a 
brownish-black  precipitate  of  copper  sulphid.     This  should 


COPPER    SULPHATE.  5  I  I 

be   corroborated   by  boiling   in   nitric   acid,  evaporating   to 
dryness,  dissolving  in  water,  and  applying  the  usual  tests. 

4.  A  piece  of  bright  iron  immersed  in  a  slightly  acidu- 
lated solution  of  copper  acquires  a  coating  of  copper.  If 
the  solution  be  very  dilute,  it  should  be  concentrated  by 
heat  and  a  very  small  iron  surface  should  be  exposed ;  a 
fine  sewing-needle  may  be  suspended  in  it  for  some  hours. 
After  it  has  received  the  copper  coating,  it  may  be  removed 
and  put  into  a  porcelain  capsule,  with  a  little  ammonium 
hydroxid,  which,  in  a  short  time,  will  assume  a  blue  color. 

5.  The  galvanic  test  consists  in  placing  the  copper  solu- 
tion, slightly  acidulated,  in  a  platinum  dish,  and  touching 
the  latter,  through  the  liquid,  with  a  piece  of  zinc.  The 
copper  will  be  deposited  on  the  platinum  in  the  form  of  a 
reddish  incrustation.  The  latter  may  be  dissolved  off  the 
platinum  by  dilute  nitric  acid,  evaporating  to  dryness, 
moistening  it  with  water,  and  testing  it  as  above  directed. 

Toxicologic  Examination.  —  A  portion  of  the  copper  may 
be  found  in  a  soluble,  and  some  in  an  insoluble,  state.  The 
liquid  part  has  usually  a  bluish  or  greenish  color.  This 
should  be  filtered,  concentrated  by  heat,  and  a  trial  test,  by 
means  of  a  bright  sev/ing-needle,  applied.  Any  reddish 
deposit  on  the  latter  should  be  examined,  as  above  men- 
tioned. Sometimes  the  needle  may  acquire  a  reddish  coat- 
ing simply  from  ferric  oxid  ;  ammonium  hydroxid  will  seive 
to  distinguish  them.  If  a  large  amount  of  copper  should 
be  indicated,  hydrogen  sulphid  should  be  passed  though  it 
until  all  the  copper  is  precipitated.  This  precipitate  is  to 
be  treated  after  the  manner  above  described.  If  the  amount 
of  copper  be  extremely  small,  the  galvanic  test  is  the  most 
suitable.  The  filtered  liquid,  acidified  with  sulphuric  acid, 
is  placed  in  a  platinum  capsule,  and  fragments  of  pure  zinc 


5  1 2  TOXICOLOGY. 

are  put  into  it ;  wherever  there  are  points  of  contact  between 
the  two,  there  will  be  a  reddish  deposit  on  the  platinum. 
This  should  be  washed,  and  the  copper  dissolved  off  with  a 
drop  or  two  of  dilute  nitric  acid.  The  nitric  solution  is  to 
be  evaporated  to  dryness,  diluted  with  water,  and  tested  as 
before  described. 

If  neither  of  the  above  tests  reveals  the  presence  of  copper, 
it  cannot  be  present  in  the  liquid  matters  ;  but  the  solids 
may  possibly  contain  it.  These  should  be  boiled  with  dilute 
hydrochloric  acid  and  water,  filtered,  concentrated  by  heat 
and  tested. 

Traces  of  arsenic  are  sometimes  found  in  the  sulphate  ; 
when  the  latter  has  been  taken  as  an  emetic,  traces  of  this 
substance  have  been  discovered  in  the  matter  vomited,  and 
in  the  stomach  (Taylor). 

In  searching  for  the  salts  of  copper  in  the  stomach,  this 
organ  should  be  carefully  examined  for  blue  or  green  par- 
ticles. After  treating  the  stomach  and  its  contents  in  the 
usual  manner,  with  the  addition  of  water  and  hydrochloric 
acid,  and  filtering  and  concentrating  by  heat,  the  iron  and 
galvanic  tests  may  be  used  as  trial  tests.  Hydrogen  sulphid 
should  then  be  passed  through  the  liquid  until  all  the  copper 
sulphid  is  precipitated.  This  precipitate  should  be  washed, 
boiled  in  dilute  nitric  acid,  and  evaporated  to  dryness ;  if 
much  organic  matter  is  present,  it  should  be  moistened  with 
strong  nitric  acid  and  heated  until  all  the  organic  matter  is 
destroyed.  The  dry  residue  is  now  dissolved  in  dilute  nitric 
acid,  and  again  evaporated  to  dryness,  dissolved  in  water, 
and  the  usual  tests  applied. 

In  the  Organs. — These  should  be  finely  divided  and 
thoroughly  dried,  and  then  incinerated  in  a  porcelain  cruci- 
ble, and  the  resulting  ash  treated  with  pure  hydrochloric 


POISONING    BY   ZINC.  513 

acid  by  heat,  and  then  evaporated  to  dryness  ;  dissolve  in 
water  and  apply  the  usual  tests.  Copper  remains  longer 
than  arsenic  in  the  tissues  and  organs  ;  as  long  as  sixty  days 
in  the  liver  and  lungs,  according  to  Orfila. 

In  the  Urine.  —  Evaporate  six  to  eight  ounces  to  dryness; 
treat  the  residue  with  the  nitric  acid  and  potassium  chlorate, 
with  the  aid  of  heat,  to  complete  incineration.  Dissolve 
the  resulting  ash  in  hot  dilute  nitric  acid,  and  evaporate  to 
dryness.  Dissolve  the  residue  in  warm  water,  and  test  as 
above. 

Copper  is  generally  found  in  minute  amounts  in  the 
human  body,  especially  in  the  liver  and  brain.  It  is  doubt- 
less introduced  by  articles  of  food.  It  is  not  known  to  be 
hurtful  in  these  small  quantities.  It  exists  in  minute  pro- 
portions in  certain  vegetables,  which,  doubtless,  obtain  it 
from  the  soil.  The  discovery  of  faint  traces  of  copper  in 
the  body  after  death  is,  therefore,  no  proof  of  copper  poi- 
soning. 

Copper  may  be  determined  quantitatively  as  the  free  ele- 
ment, every  lOO  parts  of  which  are  equivalent  to  393.8 
parts  of  crystallized  sulphate. 


ZINC,    MAGNESIUM,    BISMUTH,   TIN,    IRON,    AND   CHROMIUM 
COMPOUNDS. 

Cases  of  Zinc-poisoning  are  comparatively  rare.  In 
the  free  state  zinc  would  soon  be  acted  upon  in  the  stomach, 
and  converted  into  a  chlorid,  which  might  occasion  serious 
results.  The  sulphate  and  chlorid  are  the  preparations 
most  Hkely  to  produce  poisonous  effects. 

The  zinc  of  commerce  (spelter)  is  apt  to  contain  arsenic 
and  other  impurities. 
43 


5  1 4  TOXICOLOGY. 

Zinc  Sulphate  {White  Vitriol). — This  is  a  white,  crystal- 
line, soluble  salt.  It  has  an  astringent  taste  ;  effloresces  on 
exposure  to  the  air.  It  acts  as  a  prompt,  active  emetic, 
without  causing  much  depression  of  the  system ;  hence  is 
indicated  in  cases  of  narcotic  poisoning.  It  is  used  in  small 
doses  as  a  nerve  tonic,  and  the  system  soon  acquires  a  tol- 
erance of  the  medicine. 

Fatal  Dose.  —  Half  an  ounce  to  an  ounce. 

Symptoms.  —  A  strong,  metallic  taste,  attended  with  a 
burning  sensation  and  constriction  of  the  throat,  nausea, 
violent  vomiting,  intense  pain  of  stomach  and  bowels, 
purging,  small  and.  frequent  pulse,  great  anxiety,  cold 
sweats,  extreme  prostration,  dilated  pupils,  coma,  and  death. 
Experiments  on  animals  show  it  to  be  a  powerful  heart 
depressant. 

Fatal  Period.  —  A  case  is  reported  of  a  woman  who 
swallowed,  by  mistake  for  Epsom  salt,  an  ounce  and  a  half 
of  this  salt,  and  death  ensued  in  thirteen  hours  and  a 
half 

Post-mortem  Appearances.  —  Decided  evidences  of  inflam- 
mation are  seen  in  the  mucous  membrane  of  the  alimentary 
canal,  such  as  redness,  softening,  ecchymoses,  and  some- 
times ulceration  ;  a  yellowish,  pultaceous  matter,  covering 
the  inner  surface  of  the  stomach  and  bowels ;  congestion 
of  the  brain  and  membranes,  also  of  the  lungs,  with  bloody 
effusion  into  the  pleura,  and  a  distended,  flabby  heart. 

Zinc  Chlorid.  —  In  strong  solution  this  is  known  as 
"  Burnett's  Disinfecting  Fluid."  It  has  been  used  as  a  dis- 
infectant and  as  a  preservative  for  wood.  It  is  a  powerful 
corrosive,  and  has  frequently  caused  death  when  taken  by 
mistake  or  for  suicide. 


ZINC ANALYTIC    METHODS.  515 

The  symptoms  are  in  general  the  same  as  those  pro- 
duced by  the  sulphate,  only  much  more  intense  in  their 
character,  and  resembling  somewhat  those  of  the  mineral 
acids.  They  come  on  immediately  after  swallowing ;  the 
matters  vomited  and  purged  are  frequently  tinged  with 
blood  and  mixed  with  shreds  of  mucous  membrane  ;  froth 
may  issue  from  the  mouth,  and  a  white  appearance  of  the 
inside  of  this  cavity  has  been  noticed.  There  may  also  be 
loss  of  voice. 

Fatal  Period.  — Taylor  records  the  most  rapidly  fatal  case 
—  four  hours.  On  the  other  hand,  the  case  may  become 
chronic,  lasting  for  years,  and  ending  in  stricture  of  the 
esophagus  and  exhaustion. 

Post-mortem  Lesions.  —  In  addition  to  the  usual  inflamma- 
tory signs  those  of  a  corrosive  will  be  noticed,  such  as  ero- 
sion or  destruction  of  the  coats  of  the  stomach.  Sometimes 
these  are  hard  and  leathery,  thickened,  and  corrugated. 
The  pylorus  has  been  found  constricted,  and  appearing  as 
if  cauterized.  Constriction  of  the  esophagus  iias  also  been 
noticed,  together  with  a  softened  condition  of  its  mucous 
membrane.  The  brain  and  lungs  are  congested  ;  the  heart 
not  affected,  but  usually  distended.  The  blood  is  dark  and 
uncoagulated. 

Treatment. — Assist  the  evacuation  of  the  poison  by  the 
free  use  of  mucilaginous  drinks.  The  best  antidote  is  albu- 
min, as  in  corrosive  sublimate  and  copper-poisoning.  Milk 
should  be  freely  used.  Opium  should  be  given  to  combat 
the  irritation. 

Analytic  Methods.  —  In  the  solid  state  the  sulphate  may 
be  distinguished  from  Epsom  salt  and  oxalic  acid  (which  it 
much  resembles  in  appearance)  by  exposing  a  small  frag- 
ment, mixed  with  sodium  carbonate  on  a  piece  of  charcoal, 


5l6  TOXICOLOGY. 

to  the  flame  of  the  blowpipe  ;  it  quickly  fuses  and  the  vapor 
forms  an  incrustation  on  the  charcoal,  which  is  first  yellow, 
and  becomes  white  on  cooling.  A  solution  of  potassium 
dichromate  applied  to  a  crystal  of  zinc  sulphate  turns  it 
yellow,  which  is  not  the  case  with  Epsom  salt. 

In  Solution. — (i)  The  alkalies  precipitate  the  white 
hydroxid,  which  is  soluble  in  excess  of  the  precipitant. 
(2)  The  alkaline  carbonates  throw  down  the  white  carbon- 
ate, insoluble  in  excess  of  the  precipitant,  but  soluble  in 
excess  of  ammonium  carbonate.  (3)  Potassium  ferro- 
cyanid  gives  a  white  precipitate.  (4)  Hydrogen  sulphid 
throws  down  the  white  sulphid,  soluble  in  hydrochloric 
acid.  This  should  always  be  verified  by  dissolving  it  in 
hot  hydrochloric  acid,  filtering,  diluting,  and  subjecting  it 
to  the  other  tests. 

Toxicologic  Examination.  —  In  a  case  of  suspected  poison- 
ing it  should  always  be  remembered  that  zinc  sulphate 
may  have  been  administered  as  an  emetic  ;  hence,  although 
discovered  in  the  body  after  death,  it  may  not  have  been 
the  actual  cause  of  death.  If  found,  other  poisons  should 
also  be  sought  for.  The  organic  matters,  along  with  a 
little  acetic  acid,  should  be  gently  heated  for  some  time  in 
order  to  dissolve  out  the  zinc  that  may  have  combined  with 
albumin,  fibrin,  etc.  After  cooling,  the  solution  should  be 
filtered  and  concentrated,  and  then  treated  with  hydrogen 
sulphid.  The  precipitated  sulphid  is  collected  on  a  filter, 
washed,  and  dissolved  in  strong  nitric  acid.  The  nitrate  is 
evaporated  to  dryness,  dissolved  in  water,  and  subjected  to 
the  usual  tests. 

As  the  preparations  of  zinc  usually  contain  iron,  the 
presence  of  the  latter  metal  will  more  or  less  modify  the 
reactions  of  the  former.     The  iron  may  be  separated  by  an 


MAGNESIUM    SULPHATE.  51/ 

excess  of  ammonium  hydroxid,  which  will  precipitate  the 
iron  oxid,  while  it  retains  the  zinc  oxid  in  solution. 

The  tissues  (liver,  kidney,  spleen,  etc.)  may  be  examined 
either  by  boiling  with  dilute  nitric  acid,  evaporating  to  dry- 
ness, and  adding  small  quantities  of  nitric  acid,  and  heating 
until  all  the  organic  matter  is  destroyed,  or  else  by  inciner- 
ating the  perfectly  dried  viscera  in  a  porcelain  crucible,  and 
treating  the  resulting  ash  with  nitric  acid  ;  evaporating  to 
dryness,  and  dissolving  the  residue  in  water ;  acidulate  with 
hydrochloric  acid  ;  again  evaporate  to  dryness  ;  dilute  with 
water,  and  apply  the  usual  tests. 

Zinc  chlorid  is  frequently  present  in  embalming  solutions. 

Quantitative  Estimate.  —  Zinc  is  usually  determined  as 
oxid.  The  boiling  solution  is  precipitated  with  sodium 
carbonate.  The  precipitate  is  collected  on  a  filter,  washed 
and  dried,  and  then  ignited.  Every  loo  grains  represent 
354.13  grains  of  crystallized  sulphate,  or  i6'j.'j'j  grains  of 
zinc  chlorid. 

Magnesium  Sulphate. — Epsom  Salt. — This  household 
aperient  is  generally  regarded  as  entirely  safe,  but  the  fol- 
lowing case,  reported  by  Neale,  shows  the  serious  symptoms 
that  a  large  dose  may  cause.  A  boy,  1 5  years  old,  took 
one  ounce  of  the  drug  at  a  dose.  Three  evacuations  oc- 
curred and  in  a  few  hours  he  became  sick  and  vomited  fre- 
quently. He  did  not  receive  medical  attendance  until  the 
next  day,  when  he  was  found  in  a  position  of  flexion,  except 
that  he  occasionally  rolled  on  his  stomach.  He  was 
apathetic,  but  conscious  and  was  deeply  cyanosed  ;  pressure 
on  the  skin  caused  white  marks  which  remained  for  a  long 
while,  showing  an  extremely  sluggish  circulation.  The 
conjunctiva  was   deeply  injected,  the  pupils   unequally  di- 


5  I  8  TOXICOLOGY. 

lated.  The  covered  parts  of  the  body  had  a  roseolous  rash, 
and  a  zone  of  herpes  zoster  developed  in  the  left  submam- 
mary area.  Tetanic  spasms  occurred  occasionally  in  the 
right  arm  and  on  the  right  side  of  the  face.  Sordes  existed 
on  the  tongue  and  teeth,  the  abdomen  was  distended  and 
the  urine  was  not  retained.  No  radial  pulse  was  perceptible 
on  the  right  and  only  a  feeble  one  on  the  left  side.  The 
heart's  action  was  weak  and  could  not  be  counted.  The 
hands  and  feet  were  cold,  although  the  axillary  tempera- 
ture was  105°  F.  Under  stimulant  treatment  he  recovered 
rapidly  and  completely.  An  analysis  of  a  portion  of  the 
salt  remaining  from  that  taken  showed  that  it  was  pure 
magnesium  sulphate. 

Two  other  cases  of  poisoning  by  this  substance  are  noted 
in  the  report  of  the  above  case.  Both  resulted  fatally.  In 
one  case,  an  adult  took  one  ounce ;  in  the  other,  a  boy  of 
ten  years  was  killed  by  two  ounces. 

Bismuth  Subnitrate  {Bisrmith  Oxynitrate — Magisterj  of 
Bismuth — Pearl  White). — This  substance  is  considerably 
employed,  both  medicinally  and  as  a  cosmetic.  As  a 
medicine  it  is  given  in  doses  of  five  to  thirty  grains. 
Several  fatal  cases  have  been  reported  as  resulting  from 
large  doses,  the  symptoms  being  those  of  a  violent  irritant 
poison.  Many  authorities  ascribe  these  results  to  the 
adulteration  of  the  bismuth  with  arsenic.  Taylor  states 
that  this  adulteration  is  veiy  common,  and  that  he  detected 
arsenic  in  comparatively  large  quantities  in  three  out  of  five 
specimens  obtained  from  London  druggists. 

This  impurity  may  essentially  modify  an  opinion  as  to 
the  presence  of  arsenic  in  a  body  when  bismuth  has  been 
previously  administered  medicinally.      A  case  occurred  in 


SALTS    OF    TIN-  519 

which  it  was  contended  that  the  trace  of  arsenic  alleged  to 
have  been  discovered  in  the  liver  of  the  deceased,  was  to 
be  ascribed  to  the  bismuth  subnitrate  which  had  been  taken 
before  death.  Some  of  the  same  material  was  found  to  be 
contaminated  with  arsenic.     The  prisoner  was  acquitted. 

Bismuth  subnitrate  is  in  the  form  of  a  white  powder,  in- 
soluble in  water,  but  soluble  in  nitric  acid.  The  solution 
thrown  into  water  yields  a  copious  white  precipitate,  which 
is  blackened  by  ammonium  sulphid,  and  is  not  soluble  in 
tartaric  acid. 

Dreesman  reports  a  case  in  which  after  the  use  of  an 
ointment  containing  ten  per  cent,  of  bismuth  subnitrate,  on 
an  extensive  burn,  a  black  sediment  appeared  in  the  urine 
in  the  third  week.  Three  weeks  later  a  marked  inflammation 
of  the  mouth  occurred,  with  pain  and  difficulty  in  swallow- 
ing ;  the  gums  showed  a  blue-black  tinge.  The  substitu- 
tion of  a  boric  acid  ointment  was  followed  by  immediate 
improvement.  Analysis  showed  that  the  bismuth  was  free 
from  other  poisonous  substances,  especially  lead. 

A  delicate  test  for  bismuth  is  a  piece  of  paper  wetted  with 
a  solution  of  potassium  thiocyanate  and  dried  ;  a  yellow 
spot  appears  at  the  point  of  contact.  It  is  stated  that  the 
urine  will  reveal  the  presence  of  bismuth,  a  few  hours  after 
taking  the  subnitrate,  by  means  of  this  test. 

Salts  of  Tin. — The  only  preparations  of  tin  requiring 
notice  are  the  chlorids.  The  effects  of  these  salts  upon  the 
system  are  those  of  the  metallic  irritants  ;  but  the  instances 
of  poisoning  by  them  are  rare. 

Stannous  chlorid,  tin  dichlorid,  gives  a  brown  precipitate 
with  hydrogen  sulphid.  Corrosive  sublimate  throws  down 
the  mercury.     Gold  chlorid  gives  a  fine  purple  precipitate 


5  20  TOXICOLOGY. 

—  the  purple  of  Cassius.     A  fragment  of  zinc  precipitates 
metallic  tin  in  an  arborescent  form. 

Starmic  clilorid,  tin  tctracJilorid,  is  precipitated  yellow  by- 
hydrogen  sulphid.  This  sulphid  is  distinguished  from 
arsenous  sulphid  by  being  insoluble  in  ammonium  hydroxid, 
and  from  cadmium  sulphid  by  being  insoluble  in  hydro- 
chloric acid.  Corrosive  sublimate  and  gold  chlorid  yield 
no  precipitate  with  it. 

The  preparations  of  silver,  gold,  and  platinum  (with 
some  allied  bodies)  are  all  highly  irritant  and  corrosive ; 
but  they  so  rarely  are  the  occasion  of  poisoning  in  the 
human  subject  that  they  need  no  further  discussion  here. 

Iron  Compounds. — Ferrous  sulphate  (green  vitriol)  is 
highly  irritant  in  large  doses,  having  proved  fatal  in  several 
instances.  Its  action  resembles  that  of  copper  sulphate, 
though  less  violent. 

Ferric  chlorid  in  the  form  of  tincture  (muriated  tincture 
of  iron)  is  much  used  in  medicine.  In  large  doses  it  acts  as 
a  violent  corrosive  poison.  Christison  records  the  case  of 
a  man  who  swallowed,  by  mistake,  an  ounce  and  a  half  of 
the  liquid,  and  who  died  in  about  five  weeks.  It  is  occa- 
sionally used  as  an  abortive. 

Preparations  of  Chromium.  —  The  salts  of  chromium 
most  used  in  the  arts  are  the  potassium  chromate,  dichro- 
mate,  and  lead  chromate.  The  two  former  are  violent  irri- 
tants in  large  doses ;  sometimes  acting,  also,  as  corrosives 
to  the  lining  membrane  of  the  alimentary  canal.  The  latter 
has  been  noticed  under  Lead. 

Potassium  dichromate  may  be  distinguished  —  (i)  by  its 
deep  orange-red  color ;    (2)  by  solution  of  lead    acetate, 


POISONING    BY    OXALIC    ACID.  521 

which  precipitates  the  yellow  lead  chromate  ;  (3)  by  silver 
nitrate,  which  throws  down  a  deep  red  precipitate  ;  hydro- 
gen sulphid  gives  a  dingy  green  sulphid. 

OXALIC  ACID. 

Various  oxalates,  especially  acid  potassium  oxalate  and 
calcium  oxalate,  occur  frequently  in  plants,  e.  g.,  rhubarb, 
wood-sorrel,  dock,  lichens,  etc.  Oxalic  acid  is  extensively 
used  in  the  arts,  under  misleading  names.  It  is  rarely 
employed  for  homicidal  poisoning,*-  since  it  would  be  easily 
detected  by  its  sour  taste ;  but  it  is  sometimes  resorted  to 
for  suicidal  purposes,  and  it  has  been  frequently  the  cause 
of  accidental  death,  from  its  being  mistaken  for  magnesium 
sulphate  (Epsom  salt),  which  it  resembles  in  appearance. 

Symptoms. — These  depend  very  much  on  the  size  of  the 
dose  and  the  degree  of  concentration.  In  the  quantity  of 
half  an  ounce  to  an  ounce,  it  acts  as  a  prompt,  violent,  cor- 
rosive poison.  In  smaller  doses  and  more  diluted,  its  irri- 
tant effects  may  be  much  lessened  or  altogether  lost ;  but 
its  remote,  specific  operation  on  the  heart  and  nerve-centers 
is  very  observable  in  the  acute  pain  in  the  back,  extending 
down  the  limbs,  attended  with  tingling  and  numbness,  and 
with  tetanic  spasms,  together  with  occasional  narcotism. 
On  the  heart  it  acts  as  a  decided  depressant. 

When  swallowed  in  a  very  large  dose,  and  dissolved  in  a 
small  quantity  of  water,  the  effects  are  immediate.  An 
intensely  sour  taste  is  followed  by  a  burmng  sensation  in 
the  gullet,  extending  down  to  the  stomach  ;  violent  pain  in 
the  abdomen,  mcreased  by  pressure ;  constriction  of  the 
throat ;  vomiting  of  a  greenish-brown  or  black  matter, 
sometimes  mixed  with  blood.  If  the  patient  lives,  purging 
of  a  similar  character  sets  in.  The  remaining  symptoms 
44 


522  TOXICOLOGY. 

are  those  of  collapse,  such  as  extreme  debility,  a  cold, 
clammy  skin,  feeble,  rapid  pulse,  and  hurried  respiration. 
There  are  also  soreness  of  the  mouth,  swelling  of  the 
tongue,  intense  thirst,  restlessness,  and  distressing  cough  ; 
also,  frequently,  cramps,  and  numbness  of  the  legs  and 
arms,  loss  of  voice,  acute  pain  in  the  back  and  head,  de- 
lirium and  convulsions  —  symptoms  that  indicate  the  action 
of  the  poison  on  the  nervous  system.  As  in  the  case  of 
other  violent  poisons,  the  above-mentioned  symptoms  are 
liable  to  many  exceptions  and  anomalies ;  thus,  vomiting 
and  pain  may  both  be  absent. 

Christison  mentions  a  case  in  which  leeches  that  had  been 
applied  to  the  epigastrium  of  a  patient  who  had  been  poi- 
soned by  this  acid,  fell  off  dead,  showing  evidently  that  it 
had  passed  into  the  circulation.  In  cases  of  poisoning  the 
urine  may  contain  crystals  of  calcium  oxalate  in  abundance  ; 
also,  albumin  and  tube-casts,  and,  according  to  some  writers, 
deposits  of  similar  crystals  are  found  within  the  tubules. 

Fatal  Dose.  —  Half  an  ounce  to  an  ounce  is  regarded  as  a 
fatal  dose  for  an  adult.  Dr.  Taylor  quotes  a  case  where 
one  drachm  of  solid  crystals  proved  fatal  to  a  boy  sixteen 
years  old  in  eight  hours.  There  are,  however,  cases  on 
record  where  much  larger  doses  have  been  swallowed  with- 
out causing  death. 

Fatal  Period.  —  In  a  large,  concentrated  dose,  oxalic  acid 
is  one  of  the  most  energetic  poisons  known.  Christison  calls 
it  "the  most  rapid  and  unerring  of  all  the  common  poisons." 
Ogilvie  reports  the  most  rapidly  fatal  case  known,  where 
death  occurred  in  three  minutes  after  swallowing  it.  In 
other  cases,  death  has  followed  in  ten  minutes  ;  the  majority 
of  cases  prove  fatal  within  one  hour.  Again,  instances 
have   occurred  where  the  patient    has  survived    for  many 


OXALIC    ACID POST-MORTEM     APPEARANCES.  523 

hours,  and  even  days.  Beck  alludes  to  the  case  of  a  woman 
who  died  from  the  secondary  effects  of  the  poison,  after 
several  months  of  suffering. 

Treatment.  —  This  should  be  prompt,  in  order  to  be  of  any 
service.  The  best  antidotes  are  chalk  and  magnesia,  mixed 
up  with  milk.  The  alkalies  and  their  carbonates  are  inad- 
missible, on  account  of  their  forming  soluble  poisonous 
compounds  with  the  acid.  Lime-water  and  oil  are  use- 
ful. Opium  is  indicated  to  relieve  the  severity  of  the 
symptoms. 

Post-mortem  Appeara?ices.  —  The  lining  membrane  of  the 
mouth,  throat,  and  esophagus  will  usually  be  found  white, 
shriveled,  and  easy  of  removal ;  it  may  be  covered  over  with 
the  brown  matters  discharged  from  the  stomach.  The  mu- 
cous membrane  of  the  esophagus  may  be  entirely  separated, 
displaying  a  surface  of  a  brown  color,  and  raised  in  longi- 
tudinal folds.  The  stomach,  which  is  frequently  contracted, 
contains  an  intensely  acid,  brown,  gelatinous  fluid  ;  the 
mucous  membrane,  if  death  has  been  rapid,  may  appear 
soft  and  pale,  often  without  marks  of  decided  inflammation  ; 
but  if  death  has  been  delayed,  it  is  usually  black  in  some 
places,  and  in  others  intensely  congested  and  in  rugse,  with 
portions  peeling  off,  revealing  a  gangrenous  condition  of 
the  subjacent  tissue.  Such  cases  resemble  those  of  sul- 
phuric acid  poisoning.     Perforation  of  the  stomach  is  rare. 

The  intestines  are  usually  highly  congested,  if  death  has 
been  at  all  delayed.  The  lungs  generally  and  the  brain 
occasionally,  have  been  found  congested.  The  heart  is 
sometimes  quite  empty,  and  at  others  distended  with  dark 
blood.  The  kidneys  exhibit  a  peculiar  white  zone  in  their 
cortical  parts,  which  the  microscope  shows  to  be  owing  to 
an  accumulation  of  calcium  oxalate.     The  blood  through- 


524  Toxicology. 

out  the  body  is  fluid.     A  few  cases  have  occurred  where  all 
morbid  appearances  have  been  absent. 

Analytic  Methods.  —  (i)  As  a  solid.  When  pure,  it  occurs 
in  colorless  four-sided  crystals,  of  an  intensely  sour  taste 
(by  which  it  is  immediately  distinguished  from  magnesium 
sulphate),  soluble  in  water,  especially  hot ;  soluble,  also,  in 
alcohol,  but  insoluble  in  ether,  and  nearly  so  in  chloroform. 
It  is  completely  volatilized  by  heat,  leaving  no  residue  ;  this 
is  not  the  case  with  the  magnesium  and  zinc  sulphates,  for 
which  it  has  been  mistaken. 

(2)  As  a  Liquid.  — It  reddens  litmus  paper  ;  a  drop  evapo- 
rated to  dryness  leaves  long,  slender  prisms,  {a)  Silver 
nitrate  gives  a  copious  white  precipitate  of  silver  oxalate, 
distinguished  from  the  chlorid  and  cyanid  by  being  soluble 
in  cold  nitric  acid.  If  this  precipitate  is  thoroughly  dried 
and  heated  on  platinum  foil,  it  is  completely  dissipated  in  a 
white  vapor,  in  a  succession  of  puffs  or  slight  detonations. 
W)  Calcium  sulphate  gives  a  white  precipitate  of  calcium 
oxalate,  which  is  distinguished  from  the  carbonate  and 
phosphate  by  being  insoluble  in  acetic  acid,  but  being  solu- 
ble in  nitric,  and  rather  less  so  in  hydrochloric  acid.  Cal- 
cium sulphate  will  also  precipitate  solutions  of  barium, 
strontium,  and  lead ;  but  these  sulphates  are  insoluble  in 
nitric  acid,  {c)  Barium  chlorid,  strontium  nitrate,  and  lead 
acetate  all  precipitate  white  ciystalline  oxalates,  which  are 
soluble  in  nitric  and  hydrochloric  acids  ;  but  these  tests  are 
of  inferior  value  to  the  former  ones.  (^)  Copper  sulphate 
yields  a  faint  bluish-white  cupric  oxalate,  which  is  almost 
insoluble  in  nitric  acid. 

Toxicologic  Examination.  —  If  the  contents  of  the  stomach 
are  highly  acid,  the  poison  may  probably  be  separated  by 
dialysis,  or  by  digestion  with  distilled  water,  at  a  moderate 


OXALIC    ACID TOXICOLOGIC    EXAMINATION.  525 

heat,  for  some  hours,  and  then  filtered,  the  filtrate  concen- 
trated, and  tested  with  copper  sulphate.  If  this  test  affords 
evidence  of  the  presence  of  oxalic  acid,  the  liquid  may  be 
evaporated  to  crystallization,  and  the  crystals  thus  obtained 
redissolved  in  pure  alcohol,  and  the  solution  again  crystal- 
lized. 

It  is  usually  recommended  to  treat  the  first  filtrate  with 
an  excess  of  solution  of  lead  acetate  ;  wash  the  precipitated 
lead  oxalate  on  the  filter  ;  then  diffuse  it  thoroughly  in  pure 
water,  and  pass  through  it  a  current  of  washed  hydrogen 
sulphid,  until  all  the  lead  and  organic  matter  is  thrown 
down.  Heat  a  Httle  while,  to  expel  the  excess  of  hydrogen 
sulphid,  then  filter,  and  crystallize  the  filtrate  by  evapora- 
tion. Purify  the  crystals,  if  necessary,  by  resolution,  and 
apply  the  usual  tests. 

It  may  happen  that  all  the  oxalic  acid  in  the  stomach 
has  been  neutralized  by  the  antidotes  that  were  adminis- 
tered, —  lime  or  magnesia,  —  in  which  case  the  contents  of 
the  stomach  would  not  be  acid.  Here,  the  inspected  solids 
should  be  collected,  and  thoroughly  washed  with  warm 
water  and  the  liquid  decanted  off;  if  this  liquid  is  acid,  it 
should  be  reserved  for  examination  ;  if  not  acid,  it  may  be 
thrown  away.  The  solids  should  then  be  diffused  in  pure 
water,  and  boiled  for  some  time  with  pure  potassium  car- 
bonate, which  decomposes  the  oxalates,  forming  soluble 
potassium  oxalate  and  insoluble  calcium  carbonate  and 
magnesium  carbonate.  These  are  separated  by  filtration, 
and  the  solution  concentrated  by  gentle  heat,  until  the 
crystals  are  formed. 

In  a  case  of  alleged  oxalic  acid  poisoning  it  might  be 
objected  that  the  presence  of  a  minute  quantity  of  oxalic 
acid  found  in   the  stomach  after  death  might  be  due  to 


526  TOXICOLOGY. 

rhubarb  or  sorrel  that  had  been  eaten  by  the  deceased. 
The  answer  to  this  is  that  if  there  is  an  entire  absence  of 
all  the  characteristic  symptoms  of  this  active  poison,  the 
discovery  of  a  small  quantity  of  the  acid  is  certainly  no 
evidence  of  poisoning ;  but,  on  the  other  hand,  if  the 
peculiar  symptoms  of  this  poison  and  morbid  lesions  are 
present,  then  the  obtaining  of  only  a  small  amount  of  th^ 
acid  should  not  negative  the  suspicion  of  poisoning. 

In  a  case  of  suspected  poisoning  by  oxalic  acid,  the  urine 
should  always  be  examined  for  an  increase  of  the  octahedral 
crystals  of  calcium  oxalate.  This  fluid  should  be  collected 
in  a  conical  glass,  and  the  sediment  which  collects  after 
some  time  should  be  examined  with  the  microscope. 

It  should,  however,  be  remembered  that  these  crystals 
may  be  found  in  the  urine  of  persons  who  have  partaken  of 
food  such  as  rhubarb  and  sorrel,  containing  oxalates. 

To  detect  free  oxalic  acid,  or  a  soluble  oxalate  in  the 
urine,  add  a  little  acetic  acid  to  dissolve  out  the  phosphates, 
if  present,  and  concentrate  to  about  one  fourth  its  bulk,  then 
add  lead  acetate  in  excess,  and  filter ;  decompose  the  lead 
oxalate  with  hydrogen  sulphid,  and  treat  the  filtered  solu- 
tion as  above  directed. 

Stains  of  this  acid  on  cloth,  parchment,  paper,  etc.,  may 
be  discovered  by  boiling  them  in  water,  and  applying  the 
usual  tests.  The  color  of  these  stains  on  black  cloth  is 
orange  and  brownish-red.  This  acid  is  sometimes  em- 
ployed to  remove  writing  ink,  in  cases  of  forgery  ;  but  usu- 
ally there  are  left  on  the  paper  traces  of  iron,  existing  in  the 
ink,  which  can  readily  be  recognized  by  applying  a  solution 
of  potassium  ferrocyanid,  which  will  turn  it  blue. 

Oxalic  acid  is  usually  estimated  quantitatively  as  lead  ox- 
alate ;  every  100  parts  of  the  dried  pure  oxalate  are  equiva- 
lent to  42.5  of  the  crystalHzed  acid. 


BORIC  ACID  AND  BORAX.        '      52/ 

Calcium  oxalate  is  almost  invariably  found  in  the  urine 
in  the  form  of  octahedral  crystals,  and  often  in  larger  masses 
constituting  "  mulberry  "  calculus. 

Acid  Potassium  Oxalate  —  {Salt  of  Sorrel — Essential 
Salt  of  Lemons). — This  salt  is  much  used  in  the  arts.  It 
is  almost  as  active  a  poison  as  oxalic  acid  ;  the  symptoms, 
dose,  and  lesions  are  very  similar  to  those  of  the  acid.  It 
is  distinguished  from  the  latter  (i)  by  heating  a  fragment 
on  platinum  foil ;  an  ash  is  left,  potassium  carbonate,  while 
the  acid  is  entirely  dissipated  ;  (2)  it  crystallizes  in  feathery 
forms  ;  (3)  it  is  distinguished  from  cream  of  tartar  by  lime 
water,  which  precipitates  both  ;  but  the  calcium  tartrate  is 
immediately  redissolved  by  tartaric  acid,  while  the  oxalate 
is  insoluble.     This  salt  is  a  natural  ingredient  in  the  sorrel. 

Tartaric  and  Acetic  Acid  act  as  powerful  irritant  poisons, 
in  the  concentrated  state,  and  in  large  doses.  They  have 
both  produced  fatal  results  when  taken  in  doses  of  an 
ounce.  Their  proper  antidotes  are  the  alkaline  carbonates, 
and  chalk  or  magnesia. 

Boric  Acid  and  Borax. — There  appears  to  be  no  evi- 
dence that  borax  has  produced  serious  results,  although 
probably  in  very  large  doses  it  would  act  as  an  irritant. 
Small  doses  of  it  may  be  taken  for  a  considerable  time 
without  apparent  injury.  The  same  is  true  of  boric  acid, 
but  the  liberal  use  of  this  in  medical  and  surgical  prac- 
tice has  led  to  disturbances  of  function  in  persons  otherwise 
in  bad  health.  Mixtures  of  boric  acid  and  borax  containing 
about  seventy  per  cent,  of  the  latter  are  much  used  as  food 
preservatives  especially  for  butter,  meat  and  milk.  The 
following  cases  have  some  interest  but  it  must  be  noted  that 


528  TOXICOLOGY. 

the  quantities  taken  were  much  larger  than  those  which 
would  be  found  in  food.  Some  cases  of  fatal  result  after 
very  large  doses  of  boric  acid  in  persons  seriously  ill  have 
been  reported. 

A  man,  aged  38  years,  took  every  4  hours  five  grains  of 
boric  acid  by  the  mouth,  and  also  had  the  bladder  washed 
out  with  a  3-per-cent.  solution.  After  several  days  the 
patient  became  very  weak,  with  small  pulse  and  a  papulo- 
vesicular eruption  appeared  on  the  backs  of  the  hands  and 
fingers.  The  symptoms  disappeared  on  withdrawing  the 
use  of  the  acid  and  returned  on  restoring  it.  In  a  second 
case,  a  man,  50  years  old,  who  had  just  been  operated  on 
for  stone  in  the  bladder,  took  the  same  doses  as  the  above 
and  at  the  14th  day  exhibited  weak  pulse,  nausea,  tempera- 
ture 102.2°  F.,  unsteadiness  and  an  eczematous  eruption 
over  the  whole  body.  On  discontinuing  the  acid  the 
symptoms  disappeared  and  reappeared  in  two  days  on  re- 
suming it. 

CARBOLIC   ACID. 

Carbolic  Acid  —  {Phenic  Acid — Phenol^  —  is  one  of  the 
products  of  the  distillation  of  coal  tar.  When  pure,  it  is  in 
the  form  of  white  acicular  crystals,  and  can  also  be  obtained 
by  synthesis,  which,  when  exposed  for  some  time  to  the 
light,  usually  acquire  a  reddish  tinge.  They  have  a  strong 
affinity  for  water,  and  liquefy  when  exposed  to  the  air.  It 
is  not,  however,  very  soluble  in  water ;  much  more  so  in 
alcohol,  ether,  and  glycerol.  It  has  a  burning  taste,  and  a 
peculiar,  strong,  creasote-like  odor.  It  is  sometimes  called 
coal-tar  creasote.  It  is  powerfully  antiseptic,  quickly  de- 
stroying minute  organisms.  Applied  in  its  undiluted  state 
to  the  skin,  it  acts  as  a  corrosive  and  anaesthetic,   cor- 


CARBOLIC    ACID TREATMENT.  529 

rugating  and  hardening  it.  Taken  internally,  undiluted,  its 
efifects  are  those  of  an  energetic,  corrosive,  and  neurotic 
poison. 

Carbolic  acid,  from  its  extended  employment  in  indus- 
tries, etc.,  has  of  late  years  become  a  very  frequent  cause 
of  poisoning. 

Symptoms.  —  Intense  burning  pain  in  the  mouth,  throat, 
and  stomach  ;  the  pupils  are  contracted  ;  the  conjunctiva 
insensible  to  the  touch  ;  marked  odor  of  the  acid  exhaled 
from  the  breath  ;  the  skin  cold  and  clammy  ;  the  tempera- 
ture rapidly  falls  ;  the  pulse  becomes  weaker  and  weaker, 
but  fluctuates  in  its  beats  ;  respiration  is  labored,  and  ulti- 
mately stertorous  ;  vomiting  of  a  frothy  mucus  sometimes 
occurs  ;  the  mouth  is  white  and  hardened  from  the  local 
effects  of  the  acid.  Coma  usually  precedes  death,  which 
may  also  sometimes  be  accompanied  by  convulsions.  Death 
may  occur  within  an  hour  from  swallowing  the  poison  ;  in 
one  case,  within  ten  minutes.  The  urine,  as  shown  by 
Stevenson,  is  often  of  an  olive -green  color. 

Many  of  the  above  symptoms  have  been  produced  by 
the  external^jpplication  of  the  acid,  especially  to  denuded 
sufaces. 

Fatal  Dose.  —  Dangerous  symptoms  have  occurred  from 
doses  of  six  or  seven  drops  or  grains.  The  deaths  recorded 
have  resulted  from  doses  of  one  to  two  ounces  ;  but  a  much 
less  quantity  would  certainly  prove  fatal. 

Treatment.  —  The  stomach  should  be  washed  out  with 
demulcent  liquids.  A  solution  of  lime  in  strong  syrup 
(saccharated  lime)  may  be  used  as  a  neutralizing  agent. 
Sodium  sulphate  is  regarded  by  some  as  a  true  antidote. 
Solution  of  soap  may  also  be  employed.  Oil  is  the  best 
outward  apphcation  to  the  skin.     Stimulants  and  strychnin 


530  TOXICOLOGY. 

may  be  given  to  combat  the  collapse.  Alcohol  is  an  effi- 
cient local  antidote.  When  the  skin  or  mucous  membrane 
of  the  mouth  has  been  injured  by  phenol,  the  prompt  use 
of  strong  alcohol  will  remove  the  blanched  appearance  and 
prevent  an  eschar.  When  the  poison  has  been  swallowed, 
whiskey  may  be  used  with  advantage.  It  is  also  claimed 
that  vinegar  is  an  antidote.  A  mixture  of  cream  and 
magnesium  sulphate  is  recommended. 

Post-mortem  Lesions.  —  The  mouth  and  esophagus  are 
usually  white,  soft,  and  corroded,  but  sometimes  hardened 
and  corrugated.  The  brain  is  generally  normal,  but  occa- 
sionally congested,  the  fluid  in  the  ventricles  exhaling  the 
strong  odor  of  the  acid.  The  lungs  are  usually  gorged 
with  blood.  The  left  ventricle  of  the  heart  is  generally 
contracted,  while  the  right  is  flaccid.  The  blood  is  uni- 
formly dark-colored  and  fluid.  The  odor  of  carbolic  acid 
is  detected  in  the  stomach,  sometimes  in  the  intestines,  and 
even  in  the  other  viscera.  The  mucous  lining  of  the  stomach 
has  been  found  white,  hardened,  and  wrinkled ;  but,  again, 
highly  congested  and  corroded.  The  bladder  is  usually 
empty,  any  urine  passed  being  of  a  dark  or  olive-green 
color. 

Afialytic  Methods.  —  The  odor  is  probably  the  best  test. 
Phenol  has  a  slight  acid  reaction,  forms  salts  with  bases  and 
imparts  a  transient,  greasy  stain  to  paper.  It  coagulates 
albumin.  It  gives  a  deep  violet  color  to  ferric  chlorid,  and 
a  bluish  tint  to  a  mixture  of  ammonium  hydroxid  and 
sodium  hypochlorite  ;  if  this  be  acidulated,  it  turns  red. 
Bromin  water  causes  a  whitish-yellow  flocculent  precipitate  ; 
if  this  be  treated  with  sodium-amalgam,  carbolic  acid  is  set 
free  (Landolt).  Heated  with  potassium  cyanid,  it  gives  a 
red  tint.     A  splinter  of  wood,  moistened  with  the  acid,  and 


LYSOL.  5  3  I 

afterward  dipped  into  nitric  or  hydrochloric  acid,  turns  of  a 
greenish-blue  tint  when  dry. 

Toxicologic  Examination.  —  Generally,  the  characteristic 
odor  of  the  acid  will  be  perceived  in  the  body  after  death. 
The  organic  matters  should  be  distilled  along  with  dilute 
sulphuric  acid. 

Carbolic  acid  can  generally  be  detected  in  the  urine,  both 
by  the  odor  and  by  chemical  reagents.  The  urine  may 
either  be  distilled  without  sulphuric  acid  (as  it  is  said  this 
acid  may  develop  carbolic  acid  from  some  of  the  normal 
constituents  of  the  urine) ;  or  by  agitating  it  with  an  excess 
of  ether,  and  subsequently  removing  the  ethereal  layer  by 
means  of  a  pipette,  and  evaporating  in  a  shallow  dish,  a 
minute  oily  residue  is  left,  having  the  character  of  carbolic 
acid, 

Lysol.  —  Lysol  is  a  coal-tar  product  containing  a  consid- 
erable amount  of  cresols  (methyl-phenols)  which  have  been 
converted  into  sodium  salts  and  thus  made  freely  soluble 
in  water.  It  is  much  used  as  an  antiseptic  wash.  Several 
cases  of  poisoning  have  occurred  in  consequence  of  the  solu- 
tion being  mistaken  for  other  drugs.  A  child  of  nearly  two 
years  drank  at  8  P.  M.,  probably  about  a  teaspoonful  of  lysol. 
Milk  was  given  immediately,  but  unconsciousness  soon 
supervened,  without  cramps  or  vomiting.  At  8.15,  when 
the  physician  saw  her,  the  pulse  was  160,  small  and  irre- 
gular, cyanosis  marked,  pupillary  and  corneal  reflexes 
absent.  The  mouth  contained  considerable  mucus.  The 
extremities  were  insensitive.  There  was  corrosion  of  the  skin 
at  the  corners  of  the  mouth,  on  the  chin  and  of  the  mucous 
surface  of  the  mouth.  The  lungs  were  edematous.  At 
8.30  P.  M.  the  stomach  was  washed  out  with  half  a  gallon 


532  TOXICOLOGY. 

of  water,  the  last  portions  of  which  gave  no  odor  of  lysol. 
Camphor  and  ether  injections  were  used.  A  few  hours 
later  the  pulse  was  improved,  the  cyanosis  and  edema  of 
the  lung  almost  gone,  the  pupils  began  to  respond  to  light, 
and  consciousness  slowly  returned.  During  the  night, 
several  attacks  of  vomiting  occurred  and  the  next  morning 
she  was  fully  conscious,  had  a  temperature  of  102.2°,  a 
pulse  of  120,  regular  and  moderately  strong;  but  marked 
dyspnea.  The  edema  of  the  lung  increased  greatly,  she 
became  unconscious,  with  almost  imperceptible  pulse,  and 
died  at  3  P.  M.,  19  hours  after  taking  the  poison.  No  post- 
mortem could  be  obtained. 

Experience  in  lysol  poisoning  shows  that  prompt  use  of 
the  stomach  pump  was  followed  by  the  recovery  of  all  the 
patients,  while  the  neglect  of  this  measure  was  almost  invari- 
ably fatal.  Solution  of  lysol  should  never  be  stronger  than 
I  per  cent,  for  external  application  and  .5  per  cent,  for  irri- 
gating internal  cavities.  It  should  never  be  used  long  at 
a  time.  One  death  has  been  known  from  the  external  ap- 
plication of  pure  lysol  on  the  intact  skin.  It  is  adminis- 
tered internally,  the  minimal  dose  should  be  taken  as  the 
standard,  and  it  should  never  be  given  except  for  a  brief 
period,  and  better  not  at  all  in  case  of  children  or  feeble 
patients.  In  the  18  cases  collected,  poisoning  occurred 
in  13  from  internal  and  in  5  from  external  use  of  the 
agent.  Nine  of  the  patients  died,  5  children  and  one 
adult  after  internal  administration,  and  2  adults  and  one 
child  after  the  application  of  pure  lysol  externally,  by  mis- 
take for  the  i-per-cent.  solution  that  had  been  ordered. 
The  largest  dose  from  which  the  patient  recovered  was  60 
grams  (925  grains),  taken  by  a  woman,  and  25  grams  (385 
grains),  by  a  four-year-old  child.     The  smallest  dose  that 


BETANAPHTHOL.  533 

proved  fatal  was  a  teaspoonful,  about  4  to  5  gm.,  of  pure 
lysol,  in  children  from  five  to  eight  years  old. 

Pyrogallol.  —  Pyrogallol  is  a  benzene  derivative,  closely 
allied  to  phenol  and  resorcinol.  It  is  much  used  as  a  de- 
veloper in  photography,  but  cases  of  poisoning  by  it  are  rare. 
The  following  instance  was  described  by  Kusch.  A  woman 
in  the  seventh  month  of  pregnancy,  suffering  from  psoriasis, 
used  on  successive  days  an  ointment  of  lo-per-cent.  pyro- 
gallol. On  the  fourth  day  alarming  symptoms  developed, 
including  marked  dermatitis,  ashen  paleness  of  face,  dysp- 
nea and  very  dark  urine  without  blood  or  albumin.  The 
temperature  was  37.2"  C.  (99°  F.),  the  pulse  regular  and 
strong.  As  the  condition  was  not  improved  on  the  suc- 
ceeding day,  premature  labor  was  induced  and  a  macerated 
fetus  removed.     The  patient  recovered. 

Blindness  from  Sodium  Salicylate.  —  Snell  has  reported 
the  case  of  a  girl  who,  after  taking  about  150  grains  of 
sodium  saKcylate,  became  totally  blind.  When  Mr.  Snell 
saw  her  she  was  in  a  dying  condition  from  heart  disease  due 
to  rheumatism,  but  the  fundus  was  apparently  normal.  She 
died  soon  after  without  recovery  of  sight.  A  few  such 
cases  are  on  record. 

Betanaphthol.  —  A  man,  aged  40,  who  had  used  a  3  per 
cent,  vaseline  ointment  of  naphthol  for  two  weeks  for  treat- 
ment of  eczema,  experienced  such  irritation  of  the  eyes 
that  the  ointment  was  discontinued.  Six  months  afterward, 
double  cataract  appeared  and  also  retinal  disturbance.  Ex- 
periments on  animals  showed  that  the  external  application 
of  the  naphthol  produces  similar  disturbances.  Benzo- 
naphthol  produced  retinal  trouble  with  hyperemic  papillae. 


534  TOXICOLOGY. 

Naphthol  seems  to  be  more   injurious    than  naphthalene, 
although  the  latter  is  also  toxic. 

Naphthalene.  —  Naphthalene,  the  well-known  substitute 
for  camphor  as  an  insectifuge,  was  observed  by  Lezenius  to 
give  rise  to  cataract.  The  following  is  the  case  :  A  man, 
36  years  old,  was  ordered,  for  an  intestinal  affection,  a  mix- 
ture of  5  grams  {yj  grains)  of  naphthalene  and  200  grams 
(about  3,000  grains)  of  emulsion  of  castor  oil.  The  compo- 
sition of  the  emulsion  is  not  given.  The  patient  took  the 
entire  amount  of  the  mixture  within  thirteen  hours.  Nine 
hours  thereafter  he  was  awakened,  after  a  quiet  sleep,  by 
severe  pain  in  the  bladder  and  found  that  he  was  blind. 
An  examination  of  the  eyes  showed  narrowing  of  the  field 
of  sight  capacity  to  distinguish  fingers  at  1.5  meters  (5  feet), 
turbidity  of  both  lenses  (which  appears  as  if  sprinkled  with 
a  white  substance  by  means  of  camel's-hair  pencil),  and 
narrowing  of  the  retinal  arteries.  The  lenses  were  extracted. 
It  was  learned  that  the  naphthalene  was  not  pure,  but  the 
nature  of  the  foreign  matter  is  not  stated  in  the  report. 

Kerosene  and  Gasolin.  —  Cases  of  severe  intoxication  with 
insensibility  sometimes  followed  by  mania,  due  to  the  drink- 
ing of  gasolin  or  inhalation  of  its  vapors  are  not  uncom- 
mon in  large  cities.  Two  cases  of  gasolin  poisoning  oc- 
curred among  sailors  in  the  Santiago  blockading  fleet  in 
1898.  They  obtained  the  gasolin  from  one  of  the  launches. 
One  man  died  and  the  other  became  insane.  Poisoning  by 
kerosene  is  common  in  some  parts  of  India.  Dr.  C.  J. 
Robertson-Milne,  of  Calcutta,  reports  fifteen  cases,  several 
of  them  in  children  less  than  three  years  old.  The  follow- 
ing notes  are  from  his  report : 


POISONING    BY    CROTON    OIL.  535 

Symptoms  of  Kerosene  Poisoning.  — Vomiting  followed  by 
signs  of  collapse,  chiefly  circulatory.  Odor  of  the  breath 
markedly  that  of  kerosene. 

Treatment.  —  The  stomach  should  be  washed  out  with 
warm  water.  Other  treatment  is  mainly  symptomatic.  The 
patient  should  be  kept  under  observation  for  at  least  twelve 
hours  and  the  possibility  of  a  sudden  fatal  issue  never  lost 
sight  of 

POISONING  BY  CROTON  OIL,  ELATERIUM,  CASTOR  BEANS, 
COLCHICUM,  AND  SAVIN. 

Croton  oil  is  a  fixed  oil,  extracted  by  pressure  from  the 
seeds  of  CrotoTt  tiglium.  It  is  used  in  medicine  as  a  power- 
ful purgative,  in  doses  of  one  or  two  drops.  In  overdoses, 
it  acts  as  a  violent  irritant  to  the  gastro -intestinal  mucous 
membrane,  causes  excessive  vomiting  and  purging,  followed 
by  collapse,  as  in  cholera.  Its  poisonous  properties  seem 
to  be  dependent  on  a  peculiar  fatty  acid  named  crotonic, 
which  exists  in  the  oil  in  variable  quantities.  When  deprived 
of  this  acid  the  oil  is  harmless. 

Croton  oil  is  of  a  light  yellow  color,  has  an  unpleasant 
odor,  and  a  hot,  acrid,  burning  taste.  Another  variety  has 
a  darker  color.  It  is  very  soluble  in  ether.  Nitric  acid, 
with  the  aid  of  heat,  imparts  to  it  a  dark-brown  color. 

Death  has  resulted  in  one  case  from  taking,  by  mistake, 
an  embrocation  containing  thirty  minims  of  the  oil.  In 
another  case,  two  and  a  half  drachms  proved  fatal  in  four 
hours  ;  while  in  a  third  instance,  half  an  ounce  of  croton  oil 
was  taken  by  mistake,  and  after  exciting  violent  vomiting 
and  purging,  with  symptoms  of  collapse,  the  patient  recov- 
ered after  fourteen  days. 

Dr.  Reese  attended  a  case  of  accidental  poisoning  by  this 


536  '  TOXICOLOGY. 

substance,  arising  from  swallowing  an  embrocation  contain- 
ing at  least  one  drachm  of  the  oil.  The  patient,  a  young 
lady,  recovered  after  experiencing  veiy  severe  symptoms. 

This  oil  has  occasionally  been  administered  with  a  poison- 
ous intent,  in  successive  small  doses,  so  as  to  produce 
symptoms  resembhng  those  of  gastro-enteritis.  A  case  of 
this  character  was  tried  at  Mount  Holly,  N.  J.,  in  which 
a  woman  was  convicted  of  an  attempt  to  poison  her  son, 
for  the  purpose  of  obtaining  his  life-insurance  money.  The 
purchase  and  possession  of  the  poison  were  ascribed  by  the 
defendant  to  having  been  intended  by  her  for  the  cure  of 
her  corns. 

Analysis.  —  Separate  the  oil  from  the  contents  of  the 
stomach  by  means  of  ether,  and  evaporate  the  ethereal 
solution  spontaneously,  and  test  the  resulting  oil  with  nitric 
acid  and  heat. 

Elaterium.  —  This  substance  is  procured  from  the  juice 
of  Ecballiiim  officiiiarum,  or  squirting  or  wild  cucumber.  It 
is  used  in  medicine  as  a  powerful  drastic  purgative.  Its 
effects  are  very  similar  to  those  of  croton  oil.  One  grain  of 
good  elaterium  has  produced  very  violent  effects.  It  owes 
its  activity  to  a  neutral  resinous  principle,  elaterin.  Nitric 
acid  has  no  action  upon  it.  Sulphuric  acid  turns  it  of  a 
reddish-brown  color. 

Castor  Beans  are  derived  from  the  Ricinus  conimunis, 
and  yield  by  pressure  the  castor  oil  of  commerce.  The 
seeds  contain  an  irritant,  poisonous  principle,  which  causes 
them  to  act  violently  when  swallowed.  They  have  occa- 
sionally proved  fatal.  In  one  case  three  seeds  destroyed 
life  in  an  adult  male  in  forty-six  hours,  and  twenty  seeds 


COLCHICUM.  537 

proved  fatal  to  a  young   lady  in   five  days,   after  violent 
symptoms,  strongly  resembling  those  of  malignant  cholera. 

Colchicum.  —  The  ColcJiiauii  mctumnale ,  or  meadow  saf- 
fron, contains  a  powerful  alkaloid  principle,  colchicin,  which 
strongly  resembles  veratrin  in  many  of  its  properties.  It 
abounds  chiefly  in  the  bulb  of  the  plant,  but  is  also  found 
in  the  seeds. 

The  effects  of  a  large  dose  upon  the  system  are  those  of 
a  violent  irritant,  such  as  burning  pain  in  the  throat  and 
stomach,  great  thirst,  vomiting,  and  soreness,  purging, 
cramps,  cold,  collapsed  skin,  feeble  pulse,  dilated  pupils, 
suppression  of  urine,  and  rapid  exhaustion.  Sometimes 
there  are  deHrium  and  convulsions. 

The  strength  of  the  preparations  of  colchicum  varies 
greatly,  depending  upon  the  time  of  gathering  the  plant, 
and  also  upon  its  place  of  growth. 

Death  has  resulted  in  seven  hours,  and  again  has  been 
delayed  for  several  days.  Generally,  it  occurs  within 
twenty-four  hours.  Less  than  half  an  ounce  of  the  wine  of 
the  root,  forty-eight  grains  of  the  dried  bulb,  and  a  table- 
spoonful  of  the  seeds  have  severally  proved  fatal.  Accidental 
poisoning  occurred  in  Montreal,  in  1873,  in  a  company  of 
eight  or  nine  persons.  They  had  freely  partaken  of  what 
they  supposed  to  be  ordinary  wine,  but  which  was  really 
wine  of  colchicum.  In  the  course  of  a  few  hours  they 
became  alarmingly  ill,  with  nausea,  vomiting,  excruciating 
pains,  purging,  cramps,  and  prostration.  Five  of  the  cases 
terminated  fatally  within  thirty-six  hours. 

Post-mortem  Appearances.  —  These  consist  of  inflamma- 
tion of  the  stomach  and  bowels.  In  some  instances  no 
morbid  appearances  exist.     In  one  case  the  pia  mater  was 

45 


538  TOXICOLOGY. 

much  congested,  when  there  was  an  absence  of  inflamma- 
tion from  the  stomach.  The  lungs  are  usually  deeply  con- 
gested. 

Colchicin  occurs  in  fine,  white  crystals.  It  is  soluble  in 
water,  has  a  feeble,  alkaline  reaction,  and  a  bitter,  acrid 
taste.  Its  best  test  is  nitric  acid,  which  gives  it  a  violet 
color,  changing  to  blue  and  brown.  It  differs  from  veratrin 
in  its  negative  action  with  sulphuric  acid.  It  may  be  re- 
covered from  organic  mixtures  by  a  modification  of  Stas' 
process.  Less  than  half  a  grain  of  colchicin  has  proved 
fatal.     There  is  no  direct  antidote. 

The  following  case  has  been  recently  reported.  A  man 
aged  40,  who  had  for  a  long  while  suffered  from  gout, 
had  been  directed  to  take  occasionally  a  granule  of  one 
milligram  (one  sixty-fifth  of  a  grain)  of  colchicin.  Finding 
much  relief  he  had  taken  four  or  five  of  the  granules  per 
day.  For  some  time  he  felt  no  special  inconvenience, 
except  8  to  10  movements  of  the  bowels  daily.  He  devel- 
oped the  following  symptoms  which  were  exhibited  when 
the  physician  saw  him.  For  36  hours  he  had  been  almost 
unable  to  move  and  was  nearly  voiceless.  The  skin  was 
cool  and  the  temperature  below  normal.  There  was  thirst 
and  nausea.  The  pulse  was  small  and  thready.  The  urine 
was  much  reduced  in  amount,  but  free  from  sugar  or 
albumin.  The  bowel-movements  were  30  to  40  in  the  day 
and  profuse,  containing  white  flocculent  matter.  A  ten- 
dency to  vomiting  was  also  exhibited.  Frequent  spasmodic 
movements  of  the  general  muscular  system  occurred,  and 
touch  excited  violent  and  painful  contractions.  The  pupils 
were  not  affected  and  the  speech  was  not  disordered.  The 
patellar  reflexes  were  increased.  It  was  evident  that  a  con- 
dition of  chronic  poisoning  by  colchicin  had  been  developed. 


SAVIN.  539 

The  use  of  the  drug  was  stopped,  injections  of  artificial 
serum  and  spartein  sulphate  were  employed  and  a  milk  diet 
advised.  The  conditions  noted  above  lasted  for  24  hours, 
when  an  abundant  secretion  of  urine  was  established,  the 
muscular  symptoms  abated  steadily  and  passed  away  in 
about  50  hours,  and  the  profuse  diarrhea  also  ceased.  It 
seemed  that  the  patient  was  out  of  danger,  but  on  the  fifth 
day  the  physician  was  suddenly  recalled  to  find  the  man 
suffering  from  fever  (temperature,  103°  F.)  and  swelling  of 
the  joints  with  severe  pain.  The  urine  was  of  moderate 
quantity  but  there  was  no  bowel-movement.  Various 
salicylates  were  administrated  and  a  strict  milk  diet  ordered. 
The  normal  condition  was  restored  in  several  weeks. 

Savin.  —  The  tops  of  the  Junipcrus  sabina  contain  a  vola- 
tile yellow  oil  (oil  of  savin),  which  may  be  procured  by  dis- 
tillation. Both  powder  and  oil  are  employed  in  medicine, 
and  both  possess  powerful  irritant  properties.  They  are 
seldom  or  never  used  as  poisons,  but  they  frequently  pro- 
duce fatal  results  when  used  as  abortives.  Although  not 
believed  to  possess  specific  ecbolic  properties,  uterine  con- 
tractions may  follow  their  powerful  irritant  effects  upon  the 
gastro-enteric  mucous  membrane ;  but  death  is  a  more  fre- 
quent result  without  the  expulsion  of  the  fetus. 

In  cases  of  poisoning  by  the  powder  this  may  often  be 
discovered  in  the  stomach  and  bowels  by  microscopic 
inspection.  The  oil  may  be  separated  by  distillation  from 
the  contents  of  the  stomach,  and  then  agitating  the  dis- 
tillate with  ether,  in  which  it  is  soluble,  and  allowing  the 
solution  to  evaporate.  It  is  recognized  by  its  peculiar 
terebinthinate  odor. 


540  TOXICOLOGY. 

Oleander  Leaves.  —  The  leaves  of  a  species  of  oleander 
are  used  in  Bulgaria  in  the  treatment  of  malaria  and  as  an 
emmenagogue.  Dr.  S.  Wateff  saw,  at  Sofia,  the  following 
case  :  An  1 8-year-old  girl,  suffering  from  gastralgia,  prepared 
an  infusion  of  forty  oleander  leaves  in  200  c.c.  (about  six  fluid- 
ounces)  of  hot  water,  and  drank  about  half  this  liquid.  She 
noticed  at  once  a  bitter  taste  and  nausea ;  vomiting  soon 
occurred  and  severe  headache  set  in.  She  fell  to  the 
ground,  although  not  unconscious,  but  the  pain  and  vomit- 
ing continued.  The  face  felt  hot,  she  had  pain  about  the 
heart,  a  sense  of  oppression  and  the  hands  were  cold  and 
blue.  A  physician  attended  her  some  hours  after  the 
poison  was  taken.  He  washed  out  the  stomach  and  sent 
her  to  the  hospital,  where  in  a  few  hours  the  stomach  was 
again  washed  out.  Everything  given  by  the  mouth  was 
promptly  rejected.  The  consciousness  was  not  disturbed  ; 
the  pulse  was  very  frequent  and  the  temperature  was  nor- 
mal. On  the  following  day  the  visible  mucous  membranes 
were  all  strongly  reddened,  the  face  bright  scarlet,  the 
pupils  much  contracted  but  reacted  to  light.  The  heart- 
beats were  weak,  but  nothing  abnormal  was  noted  in  the 
lungs.  The  pulse  was  forty  per  minute ;  the  respiration  26 ; 
the  temperature  slightly  subnormal.  The  abdomen  was 
slightly  retracted,  sensitive  in  the  region  of  the  stomach 
and  umbilicus.  During  ten  hours  100  c.c.  of  urine  were 
passed,  of  specific  gravity  of  1022,  alkaline,  and  free  from 
albumin  and  sugar.  Headache,  thirst,  nausea  and  vomit- 
ing continued.  The  next  day  the  patient  was  able  to  retain 
a  purgative,  which  produced  an  abundant  evacuation.  The 
nausea  passed  away  slowly,  but  the  pulse  remained  slow 
for  several  days,  sinking  at  one  time  to  32.  On  the  twen- 
tieth day  after  taking  the  poison  the  pulse  was  65.     The 


POISONING    BY    HELLEBORE,  541 

inquiries  provoked  by  this  case  showed  that  three  instances 
of  oleander  poisoning  had  previously  occurred  in  Sofia,  all 
being  in  women  who  had  used  the  leaves  as  abortifacients. 
All  the  patients  showed  vomiting,  slow  pulse,  dilatation  of 
the  pupils  and  premature  menstruation,  without  diarrhea. 
Dr.  Wateff  further  reports  that  the  members  of  a  family 
were  affected  with  headache,  nausea  and  slowness  of  pulse, 
which  conditions  were  ascribed  to  the  fact  that  man^  ole- 
anders were  kept  in  the  house  during  the  entire  winter. 
On  removing  the  plants  the  symptoms  ceased.  The  emana- 
tions from  the  plants  had  caused  the  trouble. 

VERATRIN  — YELLOW    JASMINE  — GELSEMIN   AND    GEL- 
SEMIC  ACID  — POISONOUS  MUSHROOMS. 

Black  Hellebore  {Helleborus  niger),  formerly  named 
Melampodium,  is  sometimes  employed  in  medicine.  It  is 
a  powerful  irritant  to  the  stomach  and  bowels,  and  has 
proved  fatal  in  overdoses,  occasioning  violent  vomiting, 
purging,  abdominal  pain,  cold  sweats,  collapse,  and  con- 
vulsions. 

Green  Hellebore  {Veratrum  viride  —  American  Hellebore 
—  Indian  Pokey — This  species  possess  very  active  prop- 
erties^ and  has  occasioned  fatal  results.  The  tincture  is  used 
in  medicine  as  a  powerful  cardiac  depressant.  Numerous 
fatal  results  have  followed  its  incautious  use.  Several 
active  alkaloidal  principles  exist  in  both  this  drug  and  in 
V.  album  —  which,  though  resembling  veratrin  in  some 
points,  are  distinct  from  it. 

White  Hellebore  {Veratrum  album). — This  is  the  most 
poisonous  of   all  the    hellebores.     The    powder    produces 


542  TOXICOLOGY. 

violent  sneezing.  Taken  internally,  it  causes  a  sense  of 
burning  heat  and  constriction  of  the  throat,  great  anxiety, 
nausea,  vomiting,  and  purging,  pain  of  the  abdomen, 
trembling  of  the  limbs,  great  prostration,  cold  sweats, 
very  feeble  pulse,  dilatation  of  the  pupils,  giddiness,  con- 
vulsions, insensibility,  and  death.  Death  has  occurred  in 
three  and  six  hours  after  taking  it.  The  active  principle  is 
Veratrin. 

Veratrin.  —  This  alkaloid,  as  above  mentioned,  exists  in 
the  V.  album  and  V.  viride,  but  it  is  usually  procured  from 
the  seeds  of  Veratruin  sabadilla.  As  found  in  the  shops,  it 
is  in  the  form  of  a  white  powder.  It  may  be  crystallized 
with  difficulty.  It  has  an  acrid,  bitter  taste,  followed  by 
a  sense  of  dryness  in  the  throat.  It  is  a  violent  irritant  to 
the  nostrils,  causing  excessive  sneezing.  It  is  insoluble  in 
water,  soluble  in  alcohol,  ether,  chloroform,  benzene,  and 
amylic  alcohol.  Heated  on  porcelain  it  melts  and  blackens, 
evolving  a  pungent  vapor. 

Effects.  —  Taylor  mentions  the  case  of  a  lady  on  whom 
the  Jg  of  a  grain  occasioned  most  alarming  symptoms,  such 
as  insensibility,  cold  sweats,  failing  pulse,  and  collapse.  It 
acts  as  a  local  irritant  to  the  stomach  and  bowels,  and  at  the 
same  time  as  a  general  depressant. 

Analytic  Methods. — The  characteristic  test  is  sulphuric 
acid.  A  drop  applied  to  the  pure  alkaloid  imparts  a  yellow 
color  to  it,  followed  by  a  reddish  tint,  which  gradually 
passes  to  a  deep  crimson.  This  change  is  brought  about 
immediately  by  heat.  Even  a  very  dilute  acid  causes  this 
reaction  by  evaporating  to  dryness.  It  is  stated  that  even 
less  than  the  5^^0^-j  of  a  grain  of  veratrin  may  be  thus  de- 
tected. 

Other  substances  give  a  red  color  to  sulphuric  acid  —  such 


YELLOW    JASMINE.  543 

as  solanin,  narcein,  salicin,  piperin,  etc.;  but  these  are  im- 
mediately colored  by  cold  sulphuric  acid,  whereas  veratrin 
requires  the  lapse  of  some  time  before  the  change  is  effected. 

Other  reagents  are  gold  chlorid,  bromin  in  hydrobromic 
acid,  and  iodin  in  potassium  iodid. 

Trapp's  test  consists  in  warming  the  colorless  solution 
of  veratrin  in  concentrated  hydrochloric  acid,  when  a  per- 
sistent dark-red  color  results. 

In  organic  mixtures,  veratrin  may  be  separated  by  a 
modification  of  Stas'  process,  and  the  ultimate  chloroform 
extract  tested  by  sulphuric  acid.  Wormley  states  that  by 
this  test  he  was  enabled  to  recognize  the  presence  of  vera- 
trin in  an  ounce  of  blood  of  a  cat  which  had  been  killed,  in 
less  than  one  minute,  by  two  grains  of  veratrin. 

Yellow  Jasmine  {Gelseniium  sempervirens). — The  root 
of  this  plant  is  considerably  employed  in  medicine,  espe- 
cially in  the  Southern  States  of  our  country,  in  the  treat- 
ment of  neuralgia  and  analogous  complaints.  It  has  fre- 
quently produced  fatal  results,  the  symptoms  somewhat 
resembling  those  produced  by  veratrin. 

The  most  prominent  of  these  are  dimness  of  vision ;  the 
motor  nerves  of  the  eye  are  attacked  first ;  objects  cannot 
be  fixed  ;  the  eyelids  become  paralyzed,  droop,  and  cannot 
be  voluntarily  raised  ;  pupils  are  dilated  ;  eyes  staring  ;  face 
congested,  though  sometimes  pale  ;  lips  livid  ;  tongue  thick, 
speech  impaired  ;  partial  paralysis  of  the  legs  ;  much  gen- 
eral prostration  ;  small  and  frequent  pulse  ;  breathing  slow 
and  labored.  Sometimes  there  are  spasms  of  the  throat ; 
and  after  large  doses  tetanic  convulsions  have  been  observed. 

The  time  when  the  symptoms  appear  varies  from  a  few 
minutes  to  an  hour  or  more  ;  and  fatal  results  have  occurred 
in  one  hour  up  to  several. 


544  TOXICOLOGY. 

Fatal  Quantity. — The  tincture  and  fluid  extract  are  offi- 
cinal preparations.  The  latter  is  about  four  times  stronger 
than  the  former.  Twelve  minims  of  the  fluid  extract  proved 
fatal  to  a  child  three  years  old ;  and  thirty-five  drops  of  the 
tincture  caused  death  in  another  case  in  an  hour  and  a  half. 
A  teaspoonful  of  the  fluid  extract  and  half  an  ounce  of  the 
tincture  may  be  considered  as  fatal  doses. 

Treatment. — Speedy  evacuation  of  the  stomach,  followed 
by  stimulants,  internal  and  external.  The  hypodermic  use 
of  large  doses  of  morphin  is  strongly  recommended  ;  also 
the  use  of  electricity. 

Wormley  succeeded,  in  1870,  in  isolating  two  distinct 
principles  from  the  G.  sempervirens  —  gelsemin  and  gelsemic 
acid. 

The  former  is  a  strong  alkaloidal,  nitrogenized  base,  and 
constitutes  about  0.25  per  cent,  of  the  dried  root;  the 
latter  is  a  non-nitrogenized  body,  crystalline  and  feebly  acid. 
Its  proportion  in  the  root  is  about  0.5  per  cent. 

Gelsemin  is  a  colorless,  odorless,  difficultly  crystallizable 
solid,  persistently  bitter  to  the  taste,  slightly  soluble  in  water 
and  alcohol,  very  soluble  in  chloroform,  ether,  bisulphid 
of  carbon,  and  benzene.     It  forms  soluble  salts. 

Sulphuric  acid  dissolves  it  without  change  of  color  if 
perfectly  pure  ;  but  as  commonly  found,  it  slowly  colors  it 
brown,  which  changes  to  a  purple  if  warmed.  If  a  frag- 
ment of  potassium  dichromate  be  stirred  in  the  acid  solution, 
a  red  color  is  produced,  which  soon  changes  to  a  blue  tint. 
In  this  respect  it  somewhat  resembles  the  reaction  of  strych- 
nin ;  but  they  can  readily  be  distinguished  by  the  action  of 
nitric  acid,  which  gives  to  gelsemin  a  bluish-green  color 
when  evaporated,  but  does  not  affect  strychnin.  These  are 
the  most  satisfactory  modes  of  recognizing  gelsemin. 


POISONOUS    MUSHROOMS.  545 

Gelsemic  Acid. — A  colorless  and  nearly  tasteless  solid, 
crystallizing  in  tufts  or  needles  ;  slightly  soluble  in  hot 
water,  very  soluble  in  ether  and  chloroform.  Its  nitric  acid 
solution,  when  treated  with  ammonium  hydro xid,  develops 
a  deep-blood-red  color,  even  in  very  minute  proportions. 

Its  sulphuric  acid  solution  when  acted  upon  by  ammo- 
nium hydroxid  immediately  produces  a  mass  of  needle- 
shaped  crystals.  This  is  an  exceedingly  delicate  test.  Its 
fluorescent  properties  also  characterize  gelsemic  acid,  in  the 
presence  of  an  alkali.  An  extremely  minute  quantity  may 
thus  be  recognized. 

The  above  two  bodies  may  be  extracted  from  organic 
mixtures,  as  the  contents  of  the  stomach,  by  the  usual  proc- 
ess pursued  for  the  alkaloids.  The  resulting  filtered  acid 
solution  should  be  taken  up  with  ether,  which  will  remove 
the  gelsemic  acid  ;  and  the  residue  rendered  alkaline,  and 
extracted  by  ether  and  chloroform  in  the  usual  manner,  to 
procure  the  gelsemin.  Wormley  succeeded  in  recovering 
both  of  these  principles  from  the  stomach  of  a  woman  who 
was  poisoned  by  three  tablespoonfuls  of  the  fluid  extract, 
several  months  after  death  ;  and  likewise  from  the  tissues 
and  blood  of  animals  poisoned  with  the  extract. 

Poisonous  Mushrooms.  —  Many  varieties  of  fungi  are 
edible,  but  a  few  possess  noxious  and  even  fatal  properties. 
It  is  not  always  possible  to  distinguish  between  the  two 
classes,  inasmuch  as  climate,  season,  and  idiosyncrasy  may 
occasion  the  difference.  The  poisonous  principles  of  some 
fungi  appear  to  be  volatile,  since  boiling  renders  them 
innocuous. 

Symptoms. — The  effects  of  poisonous  mushrooms  on  man 
are  usually  those  of  the  narcotic  irritants,  causing  violent 
46 


546  .  TOXICOLOGY. 

vomiting,  purging,  abdominal  pain,  thirst,  anxiety,  cold 
sweats,  together  with  giddiness,  dimness  of  vision,  tremb- 
ling, dilated  pupils,  delirium,  illusions,  stupor,  coma,  con- 
vulsions, and  death. 

It  is  stated  that  the  very  same  fungi  have  acted  on  some 
members  of  a  family  as  vomitants  only,  and  on  others  as 
narcotics. 

Generally,  the  symptoms  show  themselves  within  one 
hour  —  especially  the  narcotic  symptoms.  Orfila  relates  the 
following  interesting  case  of  poisoning  of  a  family  of  six 
persons  by  the  Amanita  citrina.  The  wife,  servant,  and  one 
of  the  children  had  vomiting,  followed  by  deep  stupor,  but 
they  recovered.  The  husband  had  violent  cholera  ;  he  re- 
covered also.  The  two  other  children  became  profoundly 
lethargic  and  comatose ;  emetics  had  no  effect,  and  death 
ensued.  The  individuals  who  recovered  were  not  com- 
pletely well  until  three  weeks  after  the  fatal  repast. 

Morbid  Appearances. — These  are  imperfectly  described; 
they  indicate  a  great  tendency  to  rapid  putrefaction,  lividity 
of  the  body,  fluidity  of  the  blood,  absence  of  cadaveric 
rigidity,  numerous  ecchymoses  in  the  serous  membranes 
and  parenchymatous  organs,  signs  of  violent  and  even 
gangrenous  inflammation  of  the  stomach,  and  conges- 
tion of  the  vessels  of  the  brain,  with  decomposition  of  the 
tissues. 

The  chief  interest  connected  with  this  subject  is  the  fact 
that  the  symptoms  occasioned  by  eating  poisonous  fungi 
might  easily  be  attributed  to  poisoning  —  homicidal  or 
otherwise.  A  microscopic  examination  of  the  contents  of 
the  stomach  and  bowels  will  usually  reveal  the  botanical 
character  of  the  fragments  of  the  fungi,  if  the  poisoning  has 
been  due  to  them. 


CAMPHOR.  547 

Lily  of  the  Valley  [ConvallM-ia  luajabis).  —  Huenerfauth 
reported  two  instances  in  which  he  suffered  serious  symp- 
toms, after  rectal  injections  of  glycerin.  He  had  mental 
disturbances,  palpitation  of  the  heart,  irregular,  rather  weak 
pulse  as  high  as  140  per  minute,  dyspnea,  rigors  and  cold 
extremities.  Active  vomiting  followed  the  ingestion  of  a 
cup  of  strong  tea,  and  the  more  severe  symptoms  subsided 
after  two  hours.  By  the  next  morning  the  conditio'n  was 
normal  except  slight  prostration.  In  the  second  instance, 
frequent  and  abundant  urination  was  the  most  noticeable 
condition.  An  analysis  of  the  glycerin  showed  that  it  was 
free  from  arsenic,  but  was  flavored  with  extract  of  Lily  of 
the  Valley,  and  the  case  was  probably  one  of  poisoning  by 
this  substance. 

Camphor. — Dr.  C.  J.  Robertson-Milne,  of  Calcutta, 
has  reported  the  following  case.  A  woman,  aged  39,  drank 
a  quantity  of  gin  and  beer  during  the  day  and  at  a  late 
hour  in  the  evening  swallowed  about  2  ounces  of  camphor 
liniment ;  a  paper  stating  this,  likewise  an  empty  bottle, 
were  found  beside  her. 

On  admission  at  1 1  P.  M.  she  was  semi-conscious  and 
extremely  restless,  making  constant  purposeless  movements 
of  her  arms  and  legs.  Face  flushed.  Skin  warm.  Pupils 
widely  dilated.  Conjunctivae  insensible.  Breathing  some- 
what labored,  34.  Pulse  full  and  strong,  84.  The  stomach 
washed  out  with  difficulty,  owing  to  the  inflammatory  con- 
dition of  pharynx.  A  quantity  of  brown  grumous  matter, 
food,  etc.,  smelling  strongly  of  camphor,  was  evacuated. 
The  patient  fell  into  a  deep  sleep,  awoke  six  hours  later 
and  vomited  several  times.  She  had  completely  recovered 
about  midday  and  was  taken  home. 


548  TOXICOLOGY. 

CANTHARIDES— POISONOUS  ANIMAL  FOOD— SAUSAGE  POISON 

—TRICHINOSIS— CHEESE   POISON— POISONOUS  FISH— 

PUTRESCENT  FOOD— POISONED  FLESH. 

Cantharides. — The  Cantharis  vesicatoria,  or  Spanish  fly, 
is  much  used  in  medicine,  both  externally  as  a  vesicant, 
and  also  internally.  In  large  doses  it  acts  as  a  powerful 
local  irritant  to  the  alimentary  canal,  and  also  to  the  genito- 
urinary organs.  It  is  often  used  as  an  abortive,  and  has 
not  infrequently  produced  fatal  effects  when  employed  for 
this  purpose.  It  owes  its  active  properties  to  a  crystalline 
principle  named  cantharidin,  which  exists  in  the  proportion 
of  about  one  grain  to  half  an  ounce  of  the  powder. 

Symptoms. — A  burning  sensation  in  the  mouth  and  throat, 
with  constriction  and  difficulty  of  swallowing ;  violent  pain 
in  the  abdomen,  increased  by  pressure ;  nausea,  and  vomit- 
ing of  a  bloody  mucus  and  shreds  of  membrane,  along  with 
great  thirst  and  dryness  of  the  fauces.  Soon  the  character- 
istic impression  on  the  genito- urinary  organs  displays  itself 
in  a  dull,  heavy  pain  in  the  loins,  an  urgent  and  incessant 
desire  to  urinate,  which  is  attended  with  great  pain  and  the 
voiding  of  merely  a  few  drops  of  bloody  urine,  accom- 
panied by  tenesmus.  Priapism  frequently  occurs  in  males, 
and  swelling  and  heat  of  the  labia  in  women,  together  with 
abortion,  at  times,  in  pregnant  females.  Purging  generally 
supervenes,  the  stools  being  bloody  and  mucous,  and 
accompanied  by  tenesmus.  Sometimes  there  is  profuse 
salivation,  and  in  fatal  cases,  faintness,  giddiness,  and  con- 
vulsions. If  the  substance  has  been  taken  in  the  form  of 
powder,  the  characteristic  shining  green  particles  may  gen- 
erally be  recognized  in  the  discharges  from  the  stomach 
and  bowels.  If  the  tincture  has  been  taken,  the  above 
symptoms  come  on  more  rapidly. 


CANTHARIDES POISONOUS    ANIMAL    FOOD.  549 

All  the  above  symptoms  have  been  produced  by  the  ex- 
ternal application  of  cantharides. 

Fatal  Dose. — Twenty-four  grains  of  the  powder  and  an 
ounce  of  the  tincture  have  caused  death. 

Treatment.  —  Speedy  evacuation  by  emetics  and  cathar- 
tics (castor  oil)  ;    opium,  and  stimulants. 

Post-mortem  Appearances.  —  Intense  inflammation  of  the 
mucous  membrane  of  the  alimentary  canal,  from  the  mouth 
downward,  also  of  the  ureters,  kidneys,  and  bladder.  Con- 
gestion of  the  brain  has  been  observed.  The  peculiar 
shining  green  particles  can  generally  be  distinguished  in 
the  stomach  and  bowels.  But  if  the  tincture  has  been 
swallowed,  it  will  be  necessary  to  procure  the  extraction  of 
cantharidin  from  the  organic  matters. 

Analytic  Methods.  —  The  suspected  materials  should  be 
dried,  and  digested  in  successive  portions  of  ether,  until 
exhausted ;  this  will  dissolve  out  the  cantharidin.  The 
ethereal  solution  is  to  be  evaporated  until  nearly  dry,  and 
the  residue  should  be  spread  on  oiled  silk,  and  a  portion 
applied  to  the  lips,  or  on  the  thin  portion  of  the  skin  of  the 
arm,  when  the  resulting  vesication  would  denote  the  pres- 
ence of  cantharides. 

Poisonous  Animal  Food.  —  It  occasionally  happens  that 
animal  food,  such  as  sausages,  cheese,  fish,  mussels,  etc., 
produce  poisonous  symptoms,  either  owing  to  some  idio- 
syncrasy on  the  part  of  those  who  have  partaken  of  them, 
or  depending  upon  some  noxious  agent  connected  with  the 
food  itself,  either  introduced  from  without  or  spontaneously 
generated  within. 

Such  cases  are  often  attended  with  symptoms  of  a  violent 
character,  which  naturally  suggest  poisoning,  and  they 
then  become  the  subjects  of  medico-legal  examination. 


5  50  TOXICOLOGY. 

Sausage  Poison.  —  Physicians  and  physiologists  are  dis- 
posed to  attribute  some  instances  of  so-called  sausage 
poisoning  to  the  presence  of  animal  parasites  which  live  for 
some  time  after  the  animal  is  slaughtered,  but  are  killed 
by  thorough  cooking.  When  meat  containing  the  living 
animals  is  eaten,  these  rapidly  multiply  in  the  stomach  and 
intestines,  and  penetrate  the  muscular  coat  of  these  viscera, 
and  spread  rapidly  though  the  muscles  generally,  and  pro- 
duce the  irritation  of  the  bowels  and  the  subsequent  loss 
of  muscular  power  characteristic  of  some  of  these  cases. 
In  the  other  cases  the  noxious  agent  is  undoubtedly  pto- 
mains  generated  in  the  decomposing  meat.  It  is  more  likely 
to  occur  in  uncured  sausage. 

It  may  readily  happen  that  the  symptoms  thus  occasioned 
might  be  attributed  to  poisoning  by  one  of  the  mineral  irri- 
tants. A  careful  microscopic  and  chemical  examination  of 
the  suspected  food,  or  of  a  fragment  of  a  muscle  of  either 
a  living  or  dead  subject,  will  be  necessary,  and  will  often 
reveal  the  true  source  of  the  disorder. 

The  symptoms  of  Cheese  Poisoning  are  very  similar  to 
those  of  ordinary  irritant  poisoning.  An  occasional  cause  of 
poisonous  action  of  cheese  has  been  revealed  by  the  dis- 
covery, by  Vaughan,  of  a  ptomain  to  which  he  has  given 
the  name  of  tyrotoxicon.  Instances  of  cheese  poisoning 
are  more  common  in  Germany  than  in  this  country. 

Poisonous  Fish.  —  In  certain  individuals,  probably 
through  idiosyncrasy,  many  kinds  of  fish  act  poisonously 
—  i.  e.,  they  excite  severe  gastro-intestinal  symptoms,  re- 
sembling cholera  morbus.  In  many  cases  some  chemical 
change  in  the  food  itself  has  taken  place. 

Mussels,   which    are   quite    extensively  used   in    Europe 


POISONOUS    FISH.  551 

as  food,  occasionally  produce  most  violent  and  alarming 
symptoms,  the  exact  cause  of  which  is  not  known. 

These  symptoms  are  not  of  a  uniform  character.  Some- 
times they  are  those  of  a  simple  irritant,  such  as  nausea, 
vomiting,  purging,  pain  in  the  abdomen,  cramps,  small  and 
frequent  pulse.  The  fatal  cases  disclose  on  post-mortem 
examination  evident  signs  of  inflammation.  In  other  in- 
stances the  gastro-enteric  disturbance  has  been  slight, 
while  the  nervous  symptoms  are  well  marked,  such  as 
delirium,  insensibility,  loss  of  muscular  power,  and  coma, 
with  dyspnea  and  convulsions.  Again,  the  most  conspic- 
uous symptoms  have  been  a  peculiar  eruption  resembling 
urticaria,  along  with  severe  asthma.  The  symptoms 
usually  do  not  appear  under  the  lapse  of  twenty-four 
hours ;  but  there  are  cases  where  they  come  on  very  much 
earlier.  In  fatal  cases  the  autopsy  usually  reveals  nothing 
that  v/ill  satisfactorily  account  for  the  result. 

No  rational,  adequate  cause  of  this  singular  poisonous 
action  of  the  shell-fish  had  been  discovered  until  the  recent 
researches  of  Brieger  revealed  the  interesting  fact  that  only 
those  mussels  are  poisonous  which  inhabit  certain  filthy 
waters,  whereby  they  become  diseased.  From  such  mus- 
sels he  succeeded  in  extracting  a  specific  ptomain — mytilo- 
toxin  —  a  crystalline  base,  capable  of  forming  salts.  It  is 
very  poisonous,  somewhat  resembHng  curarin  in  its  action 
on  animals. 

The  following  cases  are  interesting  in  this  connection  : 
Three  persons,  father,  mother  and  an  11 -year-old  child,  ate 
respectively,  2,  2  and  3  sardines  preserved  in  oil.  The 
child  was  taken  sick  the  next  day,  with  vomiting,  colic, 
diarrhea  and  dizziness.  Later,  disturbance  of  vision,  un- 
steadiness of  gait  and  giddiness  without  headache  occurred, 


552 


TOXICOLOGY. 


also  loss  of  consciousness  while  waking.  Sleep  was  not 
quiet  ;  the  child  became  aphonic  and  had  cramp  of  the 
larynx  and  difficulty  in  swallowing,  but  no  fever.  The 
cramp  increased  to  a  general  convulsive  movement.  On 
the  second  day  the  face  became  pale,  the  pulse  weak, 
and  fainting  fits  occurred,  followed  by  strong  convulsive 
seizures  and  death.  The  adults  were  taken  sick  on  the 
second  day.  The  mother  had  difficulty  in  swallowing,  dis- 
turbed vision  and  sensations  of  suffocation.  She  foamed  at 
the  mouth  and  lost  speech.  Vision  was  affected  but  there 
was  no  pupillary  irregularity.  Vomiting  occurred  with 
laryngeal  cramp,  formication  and  pain  in  the  limbs.  Death 
took  place  early.  The  father,  after  similar  symptoms,  de- 
veloped general  convulsions,  then  coma  and  profuse  sweat- 
ing followed  by  death.  The  autopsy  showed  high  conges- 
tion of  the  mucous  membrane  of  the  stomach  and  upper 
intestine,  with  hemorrhage  and  ecchymosis,  congestion  of 
the  pancreas,  liver,  spleen  and  particularly  the  kidneys. 
The  heart  was  normal,  contracted  on  the  left  side  and  filled 
with  blood  on  the  right.  The  brain  membranes  were  edem- 
atous. Bacterjologic  examination  of  the  blood  showed  a 
bacillus,  which  was  pathological  to  animals  but  not  intensely 
so.  It  should  be  differentiated  from  the  ordinary  bacilli  of 
meat  poisonings  and  was  regarded  as  a  form  of  the  colon 
bacillus  which  soon  lost  its  virulence.  A  sardine  remaining 
from  the  box  was  mouldy  and  emitted  a  putrid  odor. 
Neither  metallic  impurities  nor  ptomains  were  found.  Other 
boxes  of  the  same  lot  were  tested  with  negative  results. 

Putrescent  or  Decayed  Meat  often  produces  gastro- 
enteric symptoms  similar  to  those  described  above,  but 
they  may  also    be  of   a   typhoid   character,   or  resembling 


POISONED    MEAT.  553 

true  blood-poisoning.  The  game  that  has  been  kept  long 
enough  to  delight  the  taste  of  the  epicure  has  produced  a 
severe  cholera  in  persons  not  accustomed  to  its  use. 

Putrid  animal  matter  injected  into  the  blood  vessels 
proves  quickly  fatal.  Dissecting  wounds  thus  may  pro- 
duce alarming  symptoms,  which  may  terminate  in  death. 
In  most  of  these  instances  the  real  cause  of  the  trouble 
would  seem  to  be  the  production  of  one  or  more  poisonous 
ptomains  by  the  action  of  microbes. 

Poisoned  Meat.  —  The  flesh  of  an  animal  or  bird  which 
has  become  poisoned  by  arsenic,  strychnin,  or  some  other 
deleterious  substance  may  become  the  cause  of  poisoning 
to  man.  Thus,  the  common  pheasant  of  this  country 
{Tetrao  iiinbellus),  which  has  fed  upon  the  leaves  and  buds 
of  the  kalmia  (laurel),  has  proved  poisonous  to  persons 
who  have  eaten  the  birds.  It  is  known  that  the  milk  of 
cows  and  goats  that  have  fed  upon  the  Datura  stranioni'iiin 
may  prove  poisonous  to  those  partaking  of  it.  In  one  case 
of  alleged  poisoning  by  belladonna  the  defense  was  that  the 
family  had  eaten  a  rabbit  pie,  and  that  the  animal  had  fed 
upon  the  leaves  of  the  belladonna  plant,  so  that,  without 
being  affected  injuriously  itself,  it  had  conveyed  the  poison 
to  those  who  had  partaken  of  it.  Nevertheless,  many  cases 
of  poisoning  by  animal  food  which  have  been  supposed  to 
be  due  to  the  introduction  of  some  poison  into  the  animal 
before  death,  have  really  been  due  to  changes  in  the  dead 
flesh  through  the  action  of  microbes.  In  some  cases  it  has 
appeared  that  the  very  earliest  stages  of  putrefaction  pro- 
duce more  virulent  action  than  the  later  and  more  offensive 
conditions. 


554  TOXICOLOGY. 

CLASS  II.  — NEUROTIC  POISONS. 

The  second  division  of  Poisons  embraces  those  whose 
effects  are  displayed  chiefly  on  the  great  nervous  centers  — 
the  brain  and  spinal  marrow.  Their  symptoms  are  drowsi- 
ness, headache,  giddiness,  stupor,  deHrium,  convulsions,  and 
paralysis.  They  produce  little  or  no  irritation  or  inflam- 
mation on  the  mucous  membrane  of  the  alimentary  canal. 
Their  post-mortem  conditions  are  not  very  distinctly  marked, 
consisting  of  more  or  less  fullness  of  the  cerebral  vessels; 
rarely  effusion  of  serum  ;  more  rarely  still,  effusion  of  blood 
in  the  brain.  It  is  impossible  to  diagnose  a  case  of  neurotic 
poisoning  by  these  lesions  exclusively. 

OPIUM  AND   ITS    PREPARATIONS. 

Opium  and  its  preparations  give  rise  to  a  large  propor- 
tion of  poisoning  cases,  both  in  this  country  and  Great 
Britain.  According  to  the  statistics  furnished  by  Blyth, 
over  forty  per  cent,  of  all  the  cases  of  poisoning  in  England 
between  the  years  1876-80  were  due  to  opium  ;  and  these 
amounted  to  393  males  and  250  females  —  total,  643.  Out 
of  this  whole  number,  there  were  but  two  cases  of  homicide 
(infants)  ;  22.4  per  cent,  of  the  female  cases  and  30.5  of  the 
male  were  suicidal.  This  is  a  far  higher  percentage  than 
that  found  in  any  other  European  country,  or  in  the  United 
States. 

Opium  is  the  dried  juice  of  the  unripe  capsules  of  the 
poppy  {Papaver  somnifcruni).  It  has  a  complex  composi- 
tion, containing  numerous  alkaloids,  and  also  one  or  two 
acid  principles.  Among  the  alkaloids  are  morphin,  narco- 
tin,  codein,  narcein,  thebain,  and  papaverin.  Meconic  acid 
is  the  only  important  acid.     In  a  medico-legal  view,  the 


OPIUM SYMPTOMS.  555 

only  important  bodies  are  morphin  and  meconic  acid,  since, 
in  an  analysis  for  the  detection  of  opium  in  a  case  of  sus- 
pected poisoning,  the  investigation  is  narrowed  down  to  the 
discovery  and  identification  of  these  two  substances. 

It  should  be  remembered  that  different  specimens  of 
opium  differ  in  the  contained  amount  of  morphin.  The  U. 
S.  Pharmacopeia  requires  that  opium  should  contain,  when 
dried,  from  twelve  to  sixteen  per  cent,  of  morphin.  The 
tincture  {laiidanuni)  of  the  shops  is  far  from  being  of  a  uni- 
form strength,  owing  to  this  variation  in  the  amount  of  the 
active  principle  in  the  opium,  and  also  to  fraudulent  dilution. 
Laudanum  contains  about  six  grains  of  opium  to  the  fluid- 
drachm,  which  is  equivalent  to  one  grain  to  twenty  drops. 
The  Acetuni  Opii  of  the  old  pharmacopeia  is  about  double 
the  strength  of  laudanum.  It  was  made  to  imitate  the  old 
black  drop,  but  is  not  quite  so  strong.  Wine  of  opium 
(^Sydenham' s  laudanum)  is  about  the  strength  of  laudanum. 

Numerous  cases  of  poisoning  of  children  by  "  soothing 
syrups "  are  constantly  occurring  in  large  cities.  These 
preparations  are  not  of  uniform  composition,  but  opium  or 
morphin  generally  exist  in  them. 

Symptoms.  —  These  vary  according  to  the  size  of  the  dose. 
A  large,  but  not  fatal,  dose  occasions,  at  first,  general  ex- 
citement of  the  system,  as  evinced  by  increased  fulness  and 
frequency  of  the  pulse,  flushed  face,  brilhancy  of  the  eyes, 
and  increased  activity  of  the  brain.  This  is  soon  followed 
by  calm  repose,  which  in  turn  gives  place  to  profound  sleep. 
In  proportion  as  the  amount  of  opium  is  increased,  the  first 
period  of  excitement  is  shortened,  the  more  characteristic 
soporific  effects  manifesting  themselves  sooner.  In  such  a 
case  there  will  be  giddiness  and  drowsiness,  rapidly  passing 
into  profound  sleep  or  stupor,  from  which  it  will  be  difficult 


556  TOXICOLOGY. 

to  arouse  the  patient ;  this  stupor  gradually  ends  in  coma. 
The  pupils  are  contracted.  At  first,  the  pulse  is  full  and 
slow ;  subsequently  it  becomes  weak.  The  respiration  is 
generally  slow  and  stertorous  ;  the  skin  warm,  and  the  face 
flushed.  As  the  case  advances,  the  countenance  becomes 
pale,  the  lips  livid,  the  skin  cold  and  clammy,  the  respira- 
tion very  slow  —  we  have  noticed  it  reduced  down  to  five  or 
six  in  a  minute ;  the  muscles  are  relaxed  ;  convulsions 
sometimes  occur  just  before  death,  but  these  are  more  com- 
mon in  children  than  in  adults.  Sometimes  there  is  vomit- 
ing, which  is  to  be  regarded  as  a  hopeful  sign  ;  and  occa- 
sionally also  there  may  be  purging.  At  times  the  skin  is 
bathed  in  a  profuse  perspiration. 

Certain  variations  in  the  above  symptoms  should  be 
noticed.  The  pupils  are  usually  strongly  contracted ; 
toward  the  termination  of  the  case  they  may  sometimes  be 
dilated.  Occasionally  one  pupil  may  be  contracted  and 
the  other  dilated.  The  contracted  state  of  the  pupils  is 
usually  regarded  as  a  diagnostic  sign  of  opium-poisoning  ; 
but  Dr.  Wilks  has  shown  that  this  same  condition  of  the 
eyes  occurs  in  apoplexy  of  the  pons  varolii,  and  that  two 
cases  of  this  latter  disease  were  mistaken  for  opium-poison- 
ing. The  same  contraction  of  the  pupil  occurs  also  in 
uremic  poisoning,  in  the  course  of  Bright's  disease. 

First  Appearance  of  Symptoms.  —  This  will  depend  on  the 
size  of  the  dose,  the  form  of  administration,  and  the  condi- 
tion of  the  stomach  at  the  time.  As  a  rule,  the  symptoms 
usually  commence  within  an  hour  after  swallowing  the 
poison.  But  if  taken  in  the  liquid  form  and  in  full  quan- 
tity, they  may  manifest  themselves  in  a  few  minutes.  We 
have  often  seen  full  narcosis  produced  in  five  to  ten  minutes 
by  the  subcutaneous  injection  of  a  quarter  of  a  grain  of 


OPIUM FATAL    DOSE.  55/ 

morphin.  On  the  other  hand,  cases  are  reported  where  the 
symptoms  were  delayed,  even  after  swallowing  very  large 
doses,  for  many  hours.  Sometimes  a  partial  remission  of  the 
symptoms  occurs,  and  the  patient  gives  hopes  of  recovery  ; 
but  they  return  again  only  to  terminate  in  death.  There 
seems  reason  to  believe  that  alcohol  tends  to  postpone  the 
development  of  the  usual  symptoms  of  opium. 

Fatal  Period.  —  The  average  duration  of  a  fatal  case  is 
from  seven  to  twelve  hours.  Cases  are  reported  where  the 
symptoms  appeared  in  twenty-five  minutes,  and  death  in 
three  quarters  of  an  hour ;  whilst,  on  the  other  hand,  death 
has  been,  in  some  instances,  delayed  for  twenty-five  to 
forty-eight  hours. 

Fatal  Dose.  —  Four  or  five  grains  may  be  regarded  as  the 
minimum  fatal  dose  for  an  adult.  Children  are  particularly 
susceptible  to  the  action  of  this  drug  ;  in  very  young  infants, 
fatal  effects  have  resulted  from  taking  two  or  three  drops 
of  laudanum.  An  infant  may  be  narcotized  by  the  milk  of 
a  nurse  who  has  taken  opium. 

On  the  other  hand,  recoveries  constantly  take  place  from 
very  large  doses  —  even  up  to  several  ounces.  It  is  notori- 
ous that  the  human  system  soon  acquires  a  remarkable 
tolerance  for  this  narcotic  by  habit.  De  Quincey  thus 
brought  himself  to  the  daily  use  of  nine  ounces  of  lauda- 
num, which  is  equivalent  to  about  three  hundred  and  sixty 
grains  of  solid  opium. 

Occasional  instances  of  idiosyncrasy  occur  in  which  the 
susceptibility  to  the  narcotic  influence  of  opium  is  greatly 
augmented  ;  and  also,  on  the  other  hand,  where  there  seems 
to  be  a  natural  tolerance  for  the  drug.  As  regards  the 
opium  habit,  there  can  be  no  doubt  of  its  ultimate  deleteri- 
ous effects  upon  the  human  system. 


558  TOXICOLOGY. 

The  external  application  of  opium,  especially  to  an 
abraded  surface,  may  prove  highly  dangerous  and  even 
fatal  especially  in  the  case  of  infants.  Christison  relates  an 
instance  where  a  laudanum  poultice,  applied  over  the  abdo- 
men of  an  infant  to  reHeve  pain,  produced  fatal  narcotism 
in  some  hours ;  and  where  at  the  autopsy,  a  strong  odor  of 
opium  was  exhaled  from  the  body,  showing  how  completely 
the  poison  had  been  absorbed. 

Post-mortem  Appearances.  —  These  are  neither  certain  nor 
characteristic.  There  is  usually  some  fullness  of  the  vessels 
of  the  brain ;  occasionally,  extravasation  of  serum  into  the 
ventricles,  very  rarely  of  blood.  Sometimes  there  is  con- 
gestion of  the  lungs  and  other  vascular  organs.  The  blood 
is  apt  to  be  fluid.  The  stomach  and  bowels  may  be  per- 
fectly natural  in  appearance.  The  odor  of  opium  may  be 
observed  in  opening  the  body.  It  is  hence  impossible  to 
diagnosticate  a  case  of  opium-poisoning  from  the  post- 
mortem appearance  exclusively. 

Treatment.  —  Remove  the  poison  from  the  stomach  as 
speedily  as  possible  by  the  stomach-pump,  or  by  a  prompt 
emetic,  as  zinc  sulphate  or  mustard  water.  In  case  of 
inability  to  swallow,  it  has  been  recommended  to  inject 
hypodermically  a  solution  of  -Jg  of  a  grain  of  apomorphin, 
which  usually  produces  prompt  emesis.  Moderate  exercise 
by  rubbing  or  forced  walking  are  of  value  in  maintaining 
active  respirations,  but  the  violent  treatment  formerly  in 
vogue  is  not  now  approved.  Strong  coffee  has  some  anti- 
dotal power.  It  appears  that  organic  poisons,  especially 
morphin,  tend  to  be  excreted  into  the  stomach  from  the 
blood,  so  that  chemical  antidotes  are  applicable  even  when 
the  poison  has  not  been  taken  by  the  mouth. 

Potassium  permanganate  has  been  strongly  recommended 


MORPHIN.  559 

by  Dr.  Moor.  In  poisoning  by  morphin  or  its  salts  he 
advises  the  administration  of  from  ten  to  fifteen  grains  dis- 
solved in  six  to  eight  ounces  of  water,  and  this  dose  re- 
peated every  thirty  minutes  until  three  or  four  doses  have 
been  taken.  When  laudanum  has  been  taken,  it  is  advis- 
able to  add  a  few  drops  of  dilute  sulphuric  acid  to  the 
antidote. 

Physiologic  Antidotes.  —  Atropin  was  long  regarded  as 
specifically  applicable,  but  the  trend  of  opinion  at  the 
present  day  is  against  this  view.  Reichert,  who  studied  the 
physiologic  relations  of  the  two  drugs  carefully,  regards 
atropin  as  applicable  only  in  the  second  stage  of  morphin 
poisoning  and  then  only  in  limited  use.  He  suggests  that 
an  antidote  may  be  found  in  adrenalin,  a  substance  extracted 
from  the  suprarenal  capsules,  but  this  view  has  not  yet  re- 
ceived clinical  confirmation. 

Morphin.  —  When  pure,  morphin  is  in  the  form  of  color- 
less bitter  rhombic  crystals,  slightly  soluble  in  water,  sol- 
uble in  alcohol,  especially  when  hot,  almost  insoluble  in 
chloroform  and  pure  ether,  very  soluble  in  acetic  ether  and 
amyl  alcohol.  It  is  slightly  alkaline,  forming  salts  with 
acids.  Its  solutions,  in  common  with  the  other  alkaloids, 
are  precipitated  by  tannic  acid.  Its  salts  are  soluble  in 
water  and  diluted  alcohol,  but  insoluble  in  chloroform, 
ether,  amylic  alcohol,  and  pure  acetic  ether. 

The  symptoms  produced  by  morphin  resemble  those  of 
opium,  except  that  they  ordinarily  manifest  themselves 
rather  earlier  and  possibly  tend  to  produce  convulsions 
rather  more  frequently  than  opium.  Occasionally  these 
convulsions  have  been  of  a  tetanic  character,  suggesting 
the  presence  of  strychnin. 


560  TOXICOLOGY. 

Fatal  Dose.  —  One  grain  has,  on  several  occasions,  pro- 
duced death.  Dr.  Reese  saw  a  case  in  which  three  quar- 
ters of  a  grain  administered  hypodermically  proved  fatal  to 
a  man  within  twenty-four  hours.  Still  smaller  doses  thus 
administered  have  produced  fatal  effects.  On  the  other 
hand  (as  in  the  case  of  opium),  enormous  doses  have  been 
swallowed  with  impunity.  Norris  reports  a  case  in  which 
a  druggist  took,  with  suicidal  intent,  seventy-five  grains  of 
morphin  sulphate.  No  marked  symptoms  appeared  for 
an  hour  and  a  half  He  then  became  unconscious,  but 
under  active  treatment,  including  extract  of  belladonna,  he 
entirely  recovered  on  the  second  day  after  the  occurrence. 
Other  cases  have  since  been  reported  where  still  larger 
quantities  (one  of  1 20  grains)  were  taken,  where  the  patient 
recovered. 

The  external  application  of  morphin  to  an  abraded  surface 
has  been  attended  with  fatal  effects. 

There  are  no  characteristic  post-mortem  lesions  produced 
by  morphin.  The  general  appearances  are  similar  to  those 
caused  by  opium. 

Analytic  Methods.  —  Opium  is  identified  by  its  sensible 
properties  and  by  its  physiological  action  on  animals.  The 
only  mode  of  identifying  it  chemically  is  by  detecting  the 
presence  of  its  two  important  constituents,  morphin  and 
meconic  acid,  or  some  of  its  other  principles.  The  two 
former  are  chiefly  relied  on. 

Detection  of  Morphin. — I.  In  the  solid  state.  —  (i) 
Strong  nitric  acid  dissolves  it  with  effervescence,  evolving 
red  fumes,  and  gives  an  orange-red  solution,  slowly  fading 
to  yellow.  Nitric  acid  also  produces  a  deep-red  color  with 
brucin,  which,  on  the  addition  of  stannous  chlorid,  changes 
to  a  bright  purple  ;  whereas  no  change  is  produced  in  the 


MECONIC    ACID.  5^1 

case  of  morphin.  (2)  Strong  sulphuric  acid  dissolves  it 
without  change  of  color ;  if  now  a  crystal  of  potassium 
dichromate  be  added,  it  acquires  a  green  color.  (3)  Ferric 
chlorid  imparts  a  deep-blue  color  to  it,  changing  to  green 
if  added  in  excess.  In  this  test  free  acid  must  not  be 
present.  (4)  Iodic  acid,  added  to  a  fragment  of  morphin, 
along  with  freshly  made  starch,  produces  the  characteristic 
blue  color  from  the  liberated  iodin.  This  reaction,  how- 
ever, occurs  with  other  substances.  According  to  Otto,  if 
a  fragment  of  morphin  or  one  of  its  salts  be  dissolved  in 
strong  sulphuric  acid,  by  the  aid  of  heat,  and  on  cooling  a 
little  water  added,  with  a  ciystal  of  potassium  chromate,  a 
deep  mahogany-brown  color  is  produced. 

II.  In  the  liquid  state.  —  (i)  Nitric  acid,  in  excess,  gives 
an  orange-red  color,  which  becomes  light  yellow  on  boil- 
ing. (2)  Ferric  chlorid  acts  as  on  solid  morphin.  (3)  Iodic 
acid  in  carbon  disulphid,  added  to  a  solution  of  morphin, 
causes  a  pink  or  red  precipitate,  consisting  of  iodin,  in  the 
disulphid.  (4)  A  solution  freshly  prepared  by  dissolving 
five  milligrams  of  ammonium  molybdate  in  one  c.c.  of  sul- 
phuric acid,  gives  with  morphin  a  purple  or  crimson,  which 
quickly  passes  through  several  shades,  and  after  a  while 
becomes  deep  blue. 

Several  other  tests  are  given  in  analytic  manuals,  but 
they  are  of  less  value  than  those  enumerated. 

Meconic  Acid.  —  Since  this  acid  is  peculiar  to  opium,  its 
detection  affords  proof  of  the  presence  of  that  substance. 
In  its  pure  state,  it  occurs  in  the  form  of  colorless  crystals, 
tolerably  soluble  in  water,  more  so  in  alcohol. 

Tests. — (i)  Ferric  chlorid  imparts  to  either  the  solid  or 
solution  a  blood-red  color,  which  is  not  removed  by  a  solu- 
47 


^62  TOXICOLOGY. 

tion  of  mercuric  chlorid.  The  only  fallacy  likely  to  occur 
is  from  the  presence  of  a  thiocyanate,  which  yields  a  similar 
color  with  the  iron  salt.  Thiocyanates  occur  in  the  saliva ; 
but  the  red  color  thus  given  with  ferric  chlorid  is  instantly 
discharged  by  mercuric  chlorid.  Strong  acetic  acid,  or  its 
salts,  likewise  give  a  red  color  with  the  ferric  salts ;  and 
this  color,  moreover,  is  not  removed  by  mercuric  chlorid, 
but  if  the  acetate  be  previously  boiled  with  dilute  sulphuric 
acid  it  gives  no  color  with  the  iron  salt.  (2)  Lead  ace- 
tate yields  a  yellowish-white  precipitate  of  lead  meconate. 
(3)  Barium  chlorid  yields  a  white  ciystalline  deposit  of  a 
peculiar  form.  (4)  Silver  nitrate  gives  a  yellowish-white 
precipitate,  which  becomes  red  on  adding  ferric  chlorid. 

Toxicologic  Examination.  —  Sometimes,  on  opening  the 
stomach,  the  strong  odor  of  opium  is  readily  detected,  and 
also  in  the  matters  vomited.  The  discovery  of  this  poison 
in  the  stomach  is  often  unsuccessful,  owing,  probably,  to  its 
decomposition  and  absorption  in  the  body.  This  is  espe- 
cially true  in  the  case  of  infants,  in  whom  a  very  few  drops 
have  sufficed  to  destroy  life.  The  highest  authorities  unite 
in  declaring  that  the  analyst  will  fail  to  discover  the  poison 
in  the  stomach  after  death,  in  the  majority  of  the  cases.  It 
is  much  more  likely  to  be  found  in  the  vomit. 

The  stomach  should  be  cut  up  in  small  fragments,  adding 
water  with  a  little  alcohol,  and  acidulating  with  pure  acetic 
or  tartaric  acid,  and  the  whole  exposed  to  a  gentle  heat  for 
about  one  hour.  After  cooling,  it  should  be  strained 
through  muslin,  the  solid  residue  washed  with  strong  alco- 
hol and  pressed,  and  the  washings  added  to  the  first  liquid. 
The  liquid  should  then  be  evaporated  over  a  water-bath  to 
a  small  volume,  and  when  cooled  filtered  through  paper. 


MECONIC    ACID EXAMINATION.  563 

To  the  clear  filtrate,  lead  acetate  is  to  be  added  in  excess, 
which  throws  down  lead  meconate.  The  morphin  remains 
in  the  solution  as  an  acetate  or  tartrate.  These  are  to  be 
separated  from  one  another  by  filtration,  and  the  solid 
matter  washed  with  water, 

{a)  The  solid  portion,  lead  meconate,  is  to  be  diffused 
through  water,  and  treated  with  hydrogen  sulphid  gas, 
which  precipitates  lead  sulphid,  and  leaves  meconic  acid  in 
solution  ;  the  Hquid  is  filtered,  the  precipitate  washed,  and 
the  filtrate  and  washings  concentrated  on  a  steam-bath.  A 
trial  test  on  a  small  portion  of  this  liquid  by  ferric  chlorid 
may  be  made ;  if  a  deep-red  color  is  imparted,  meconic  acid 
may  be  suspected ;  to  the  remainder  of  the  liquid  the  other 
tests  may  now  be  applied.  If  present  in  sufficient  quantity, 
meconic  acid  will  crystallize  out  on  evaporation  of  the 
liquid.  If  the  quantity,  however,  be  minute,  the  liquid 
should  be  carefully  concentrated  to  a  small  volume  and  the 
characteristic  tests  employed. 

(b)  The  filtrate  from  the  lead  meconate,  containing  the 
morphin  in  the  form  of  acetate,  together  with  the  excess  of 
lead  acetate,  is  to  be  treated  with  hydrogen  sulphid  in  order 
to  remove  the  lead ;  then  filtered  and  the  filtrate  concen- 
trated by  gentle  heat  to  dryness.  The  residue  is  then 
treated  with  a  few  drops  of  warm  distilled  water  and  a  por- 
tion of  it  examined  for  morphin  by  the  nitric  acid,  iron,  and 
iodic  acid  tests ;  the  remaining  liquid  should  then  be  made 
alkaline  by  pure  potassium  carbonate  (diluting,  if  necessary, 
with  water)  ;  it  is  allowed  to  stand  for  half  an  hour,  and  is 
then  shaken  up  with  an  excess  of  absolute  ether,  which 
will  take  up  the  impurities,  leaving  the  morphine  unaffected. 
The  ethereal  solution  is  removed  by  means  of  a  pipette  and 
reserved  for  future  examination,  if  necessary.      The  remain- 


564  TOXICOLOGY. 

ing  alkaline  solution  is  now  to  be  thoroughly  shaken  with 
two  or  three  times  its  volume  of  either  a  mixture  of  two 
parts  of  absolute  ether  and  one  of  alcohol  (as  recommended 
by  Wormley),  or  of  two  or  three  volumes  of  hot  amylic 
alcohol,  or  of  a  similar  bulk  of  acetic  ether.  By  either  of 
these  processes  the  morphin  is  taken  up  by  the  solvent, 
which  floats  upon  the  top  of  the  mixture,  and  which  may 
be  removed  by  a  pipette  and  allowed  to  evaporate  spon- 
taneously on  watch-glasses.  Ordinarily  the  morphin  thus 
recovered  is  amorphous,  and  may  require  re-solution  in  hot 
alcohol  and  to  be  crystallized  thereform  by  evaporation. 

In  cases  of  poisoning  by  morphin  alone  (or  one  of  its 
salts)  the  above  process  may  be  employed,  omitting  the 
treatment  with  lead  acetate,  inasmuch  as  no  meconic  acid 
is  present. 

Detection  in  the  Tissues  and  Blood. — There  is  generally  a 
failure  to  detect  this  poison  in  the  organs  and  tissues,  or  in 
the  blood.  Yet,  on  the  other  hand,  cases  are  reported 
where  it  has  been  discovered  in  the  body  several  months 
after  death  ;  by  Stas  thirteen  months  after.  There  is  some 
doubt  about  the  detection  of  the  opium  principles  in  the 
urine,  inasmuch  as  the  results  alleged  to  have  been  pro- 
duced by  certain  reagents  and  supposed  to  indicate  the 
presence  of  morphin  or  meconic  acid  have  since  been 
shown  to  be  due  to  substances  existing  normally  in  the 
urine. 

The  toxicologist  should  be  cautioned  against  a  too  hasty 
conclusion  as  to  the  presence  of  opium,  or  its  alkaloid,  upon 
color  tests  alone.  Orfila  relates  that  Ruspini  and  Cogrossi 
found  that  decoction  of  calf's  intestines,  although  no  mor- 
phin was  present,  acted  upon  iodic  acid  and  starch  like  that 


ALCOHOL SYMPTOMS.  565 

alkaloid.  In  another  case  morphin  was  pronounced  to  be 
present  in  the  urine  by  reason  of  the  action  of  the  extract 
of  this  secretion  on  the  iodic  acid  and  urates.  In  the  em- 
ployment of  these  extraction  processes  it  must  be  remem- 
bered that  commercial  ether^  alcohol,  benzene,  etc.,  may 
contain  small  amounts  of  impurities  giving  reactions  which 
simulate  various  alkaloids. 

Inasmuch  as  the  symptoms  of  opium  poisoning  strongly 
resemble  those  of  apoplexy,  it  might  readily  happen  that 
a  case  of  the  latter  disease,  attended  with  suspicious  sur- 
roundings, might  be  mistaken  for  the  former,  and  the  con- 
tents of  the  stomach  might  even  possibly  reveal  a  red  color 
when  treated  with  nitric  acid.  If  no  morphin  (nor  meconic 
acid)  was  actually  separated,  the  examiner  wohld  not  be 
authorized  to  pronounce  upon  the  presence  of  this  poison 
simply  from  the  single  reaction  above  mentioned.  Taylor 
cites  an  instructive  illustration  of  this  hasty  conclusion,  in 
which  a  chemist  made  oath  of  the  discovery  of  "  distinct 
traces  of  morphin  "  in  the  stomach  ;  whereas,  in  reality,  no 
morphin  had  been  taken  at  all  (as  was  proved  by  an  analysis 
of  the  medicine  swallowed  by  the  deceased) ;  but  the  death 
was  due  entirely  to  natural  causes. 

ALCOHOL. 

The  poisonous  effects  of  Alcohol  may  be  either  acute  or 
chronic.  The  former  are  witnessed  in  those  cases  in  which 
a  large  quantity  of  spirits  is  taken  at  a  single  draught.  The 
latter  are  illustrated  in  the  common  dram  drinkers,  and  by 
a  train  of  symptoms  with  which  we  are,  unfortunately,  too 
familiar.     The  former  only  will  be  discussed  here. 

Symptoms  of  Acute  Poisoning.  —  These  come  on  usually  in 
a  few  minutes  after  the  ingestion  of  the  poison,  if  the  amount 


566  TOXICOLOGY. 

is  large.  They  are,  first,  giddiness,  confusion  of  ideas,  un- 
steadiness of  gait,  incoherent  talking,  followed  by  stupor 
and  coma.  The  features  have  a  vacant,  ghastly  expression, 
or  they  may  be  suffused  or  bloated  ;  the  lips  are  livid  ;  the 
pupils  usually  dilated  and  fixed ;  the  conjunctivae  are  red ; 
an  alcohoHc  exhalation  from  the  breath  is  perceived  ;  con- 
vulsive movements  of  the  limbs ;  respiration,  at  first  sterto- 
rous, becomes  more  and  more  difficult ;  a  bloody  froth  may 
appear  on  the  lips ;  involuntary  evacuations  occur,  and 
death  may  ensue  in  half  an  hour,  or  even  earlier,  after  the 
fatal  drink.  In  other  instances  the  person  may  apparently 
recover  from  the  first  effects  and  then  suddenly  become 
insensible  and  die  in  convulsions.  If  free  vomiting  occurs, 
followed  by  a  prolonged  sleep,  recovery  is  apt  to  take 
place.  The  sensibility  of  the  pupil  to  light  may  also  be 
regarded  as  a  favorable  symptom. 

The  rapidity  with  which  the  symptoms  show  themselves 
will  depend  upon  the  previous  habit  of  the  individual  and 
the  strength  and  quantity  of  the  spirit  taken.  The  very 
large  quantities  seem  to  destroy  life  by  shock. 

Acute  alcoholism  may  be  mistaken  for  opium-poisoning 
and  concussion  of  the  brain.  Usually  the  odor  of  the 
breath  is  sufficient  to  reveal  the  case,  also  the  dilated 
pupil ;  but  this  condition  of  the  eye  is  not  invariably 
present.  In  concussion  there  are  often  marks  of  injury  in 
the  head  ;  the  face  is  pale  and  cold  ;  there  is  also  an  ab- 
sence of  the  alcoholic  odor. 

Post-mortem  Appearances.  —  There  is  generally  a  remark- 
able absence  of  putrefaction  in  the  body.  The  stomach 
exhibits  marks  of  intense  congestion  in  the  deep-red  color 
of  its  Hning  membrane,  either  diffused  or  in  patches  ;  more 
or  less  congestion  of  the  brain  and  its  membranes,  with 


ALCOHOL ANALYTIC     METHODS.  567 

serous  effusion  under  the  arachnoid  and  in  the  ventricles  ; 
sometimes  there  is  a  true  apoplectic  extravasation  of  blood. 
The  lungs  are  almost  invariably  congested.  Usually  a 
strong  alcoholic  odor  is  perceived  from  the  different  tissues 
of  the  body ;  but  the  organs  for  which  the  poisonous  fluid 
displays  the  greatest  affinity  are  the  brain  and  liver. 

Alcohol  is  very  rapidly  absorbed  into  and  eliminated 
from  the  system,  so  that  if  the  person  has  survived  several 
hours  all  traces  of  it  may  have  been  removed  from  the  body. 

Treatment.  —  Immediate  evacuation  by  means  of  the 
stomach-pump  or  by  an  active  emetic ;  affusion  of  cold 
water  over  the  head  ;  a  free  supply  of  fresh  air  ;  if  there  be 
asphyxia,  galvanism  may  be  tried  ;  also  ammonium  hydroxid 
and  the  liberal  use  of  coffee  as  a  drink. 

Analytic  Methods.  —  If  the  case  has  not  been  too  pro- 
tracted, the  alcohol  may  be  recovered  from  the  stomach 
and  its  contents  by  distillation  in  a  capacious  retort  on  a 
water-bath  with  a  good  condensing  apparatus.  If  the 
materials  are  acid,  they  should  first  be  neutralized  by 
potassium  or  sodium  carbonate.  The  distillate  should  be 
mixed  with  calcium  chlorid  and  re-distilled.  The  second 
distillate  is  to  be  shaken  with  an  excess  of  potassium  car- 
bonate (which  absorbs  the  water)  and  set  aside.  The 
stratum  of  alcohol  which  rises  to  the  top  may  then  be  sep- 
arated by  means  of  a  pipette,  and  submitted  to  the  follow- 
ing tests:  (i)  Its  taste  is  hot  and  pungent;  its  odor  is 
characteristic  ;  it  burns  with  a  pale-blue  flame,  leaving  no 
carbonaceous  residue  ;  if  burnt  under  the  mouth  of  a  test- 
tube  moistened  with  lime  water,  the  carbonic  acid  will  pro- 
duce a  white  film  upon  the  sides  of  the  tube.  (3)  It  dis- 
solves camphor.  (4)  On  adding  a  solution  of  potassium 
dichromate  and  hydrochloric  acid  the  peculiar  odor  of  aide- 


568  TOXICOLOGY. 

hyde  is  developed,  along  with  the  green  color  of  chromic 
chlorid.  In  performing  this  test  Taylor  recommends  con- 
ducting the  vapor  from  the  retort  in  which  the  distillation 
is  going  on  into  a  glass  tube  containing  a  few  fibers  of 
asbestos  moistened  with  a  mixture  of  a  strong  solution  of 
the  dichromate  and  sulphuric  acid  (used  in  this  case  instead 
of  hydrochloric  acid),  when  the  merest  trace  of  alcohol 
vapor  will  be  sufficient  to  impart  the  green  coloration. 

Both  ether  and  wood  spirit  will  produce  this  last  effect 
and  Hkewise  yield  most  of  the  results  of  alcohol.  Ether 
may  be  distinguished  by  its  odor  and  by  the  yellow  color 
of  its  flame  ;  also  by  its  smoky  deposit  on  porcelain.  Wood 
spirit  may  be  recognized  by  its  peculiar  color  and  by  its 
smoky  flame  on  burning. 

In  the  Tissues.  —  The  proof  of  the  absorption  of  alcohol  is 
afforded  in  its  detection  in  the  blood,  urine,  and  different 
tissues  of  the  body.  If  there  is  a  failure  to  discover  it  in 
the  stomach  it  should  be  looked  for  in  the  brain  and  liver. 
Buchheim  has  devised  an  exceedingly  delicate  process  for 
detecting  it  in  small  quantities  in  the  blood  and  tissues, 
based  upon  the  conversion  of  the  vapor  of  alcohol  into 
aldehyd  and  acetic  acid  when  passed  over  platinum-black. 
As  much  as  possible  of  the  material,  neutralized  first  by 
potassium  carbonate,  should  be  distilled  from  a  capacious 
retort  on  a  water-bath.  The  neck  of  the  retort  should  be 
slightly  inclined,  and  be  wide  enough  to  hold  a  platinum 
tray  about  two  inches  long  and  half  an  inch  wide  contain- 
ing the  platinum-black.  Hanging  over  each  end  of  the 
tray  is  placed  a  slip  of  moistened  litmus  paper  and  touching 
the  platinum-black.  The  tray  is  now  pushed  toward  the 
body  of  the  retort.  As  soon  as  there  is  any  escape  of 
alcoholic  vapor  by  the  distillation  it  will  be  manifested  by 


METHYL    ALCOHOL.  569 

the  reddening  of  the  litmus  paper  at  the  farthest  end  of  the 
tray,  in  consequence  of  the  production  of  acetic  acid,  while 
the  paper  nearest  the  body  of  the  retort  will  remain  blue.  If 
no  reddening  of  the  paper  occurs,  no  alcohol  can  be  present ; 
if  the  reddening  rapidly  occurs,  the  tray  should  be  removed 
and  the  vapor  should  be  condensed  in  the  usual  way. 

As  both  ether  and  wood  spirit  produce  a  similar  effect 
on  platinum-black,  this  process  offers  no  advantage  over 
the  chromic  acid  process  above  described,  except  when 
putrefaction  has  taken  place,  in  which  case  the  hydrogen 
sulphid  evolved  might  reduce  the  chromate,  but  not  affect 
the  platinum-black. 

A  few  drops  of  a  liquid  containing  alcohol  added  cau- 
tiously to  a  solution  of  one  part  of  molybdic  anhydrid  in 
ten  of  strong  sulphuric  acid  gives,  on  gentle  warming,  a 
blue  color. 

To  ten  c.c.  of  a  clear  liquid  suspected  to  contain  alcohol 
add  five  drops  of  a  ten  per  cent,  solution  of  sodium  hydro xid 
and  warm  to  about  110°  F.  Then  add  drop  by  drop  with 
shaking  a  saturated  solution  of  iodin  in  potassium  iodid 
until  the  liquid  becomes  permanently  yellowish-brown.  If 
now  the  liquid  be  decolorized  by  the  further  slow  addition 
of  sodium  hydroxid,  iodoform  will  be  produced  if  alcohol 
be  present,  and  can  be  identified  by  its  color  and  crystalline 
form.  Unfortunately  this  reaction  is  caused  by  many  other 
bodies,  especially  acetone,  but  not  by  chloroform,  chloral, 
glycerol,  or  ether,  nor  by  acetic,  formic,  or  oxalic  acids. 

Methyl  Alcohol.  —  A  highly  impure  form  of  methyl  al- 
cohol obtained  from  the  products  of  distillation  of  wood  and 
commonly  called  wood-spirit,  has  been  used  for  a  long  while 
in  industrial   work.      Its  strong  unpleasant  odor  and  taste 
48 


570  TOXICOLOGY. 

have  led  to  its  use  in  England  for  the  purpose  of  rendering 
alcohol  unfit  for  drinking  purposes,  the  mixture,  called 
methylated  spirit,  being  free  from  tax.  The  preparation  of 
an  absolutely  pure  methyl  alcohol  is  difficult  and  hence 
very  little  is  known  as  to  the  therapeutic  effects  of  it.  Dr. 
Benjamin  Ward  Richardson  published  some  statements 
based  on  his  own  experiments,  in  which  he  claimed  that  it 
is  lighter  and  more  transient  as  a  stimulant  than  common 
alcohol,  and  he  suggested  that  it  might  have  therapeutic 
value  as  a  diffusible  stimulant.  Dujardin-Beaumetz,  in  an 
article  presented  to  the  French  Academy  in  1876,  stated 
that  pure  methyl  alcohol  is  more  toxic  than  ethyl  alcohol 
and,  as  might  be  expected,  the  toxic  action  is  still  higher  in  the 
commercial  impure  forms.  Unfortunately,  he  does  not  give 
any  information  as  to  how  the  pure  alcohol  was  obtained. 

Within  the  last  few  years  a  purified  methyl  alcohol  has 
been  sold  largely  under  the  trade  name  "  Columbian  spirit." 
It  is  supposed  to  be  nearly  pure  and  has  been  used  a  great 
deal,  often  surreptitiously,  as  a  substitute  for  common  alco- 
hol (ethyl  alcohol).  Numerous  instances  of  sudden  and 
serious  blindness  have  been  traced  to  the  use  of  this  ma- 
terial, and  it  seems  that  it  has  a  special  toxic  effect,  differ- 
ent, or  at  least  far  more  virulent  than  the  common  alcohol. 
This  question  cannot,  however,  be  decided  until  it  is  shown 
that  the  so-called  Columbian  spirit  is  pure  methyl  alcohol. 
It  is  not  impossible  that  some  empyreumatic  product,  of 
the  creosote  type,  perhaps,  is  retained,  since  all  the  puri- 
fied methyl  alcohol  of  commerce  is  made  from  the  crude 
material  from  wood  distillation. 

Less  than  half  an  ounce  has  produced  total  permanent 
blindness.  It  is  stated  that  three  fluidounces  have  caused 
fatal  poisoning. 


FORMALDEHYDE.  5/1 

Dr.  de  Schweinitz  reported  a  case  of  methyl  alcohol  am- 
aurosis in  which  the  pathway  of  entrance  was  the  lungs 
and  the  cutaneous  surface  of  the  hands  and  forearms. 
The  patient,  a  varnisher  and  painter  by  trade,  denied  that 
he  drank  wood-alcohol  in  any  form.  He  had,  however,  to 
use  Columbian  spirits,  the  fumes  of  which  frequently  caused 
him  to  stagger.  He  was  accustomed  to  wash' his  hands 
and  arms,  and  sometimes  his  face,  with  wood  alcohol  to  re- 
move varnish  stains.  For  two  months  prior  to  his  blindness 
he  had  used  daily  methyl  alcohol.  For  some  time  he  had 
noticed  attacks  of  misty  vision,  usually  coming  on  at  even- 
ing, and  lasting  fifteen  or  twenty  minutes. 

One  morning  he  had  a  chill  and  was  unable  to  continue 
his  labor.  The  chill  was  accompanied  by  shooting  pains  in 
the  lower  extremities.  At  midnight  of  the  same  day  he 
awoke  to  find  that  he  could  not  see  the  gasHght  in  the  room. 
The  blindness  continued  absolute  for  two  weeks.  Under 
treatment,  pilocarpine  sweating,  he  improved  so  as  to  dis- 
tinguish objects,  but  in  three  weeks'  time  vision  began  to 
fail  until  he  became  completely  blind. 

The  ophthalmoscopic  appearance  of  these  cases  is  optic 
neuritis  with  exudations  into  the  retina  and  subsequent 
atrophy.  The  caliber  of  the  retinal  vessels  is  much  dimin- 
ished, and  the  veins  are  tortuous,  containing  very  dark 
blood.  In  the  early  stages  an  absolute  central  scotoma 
and  color-blindness  are  found.  The  field  of  vision  is  con- 
tracted. The  lesion  may  be  a  primary  retrobulbar  neuritis, 
or  it  may  depend  upon  nutritive  changes  in  the  ganglion  cells 
of  the  retina.  Both  retina  and  optic  nerve  seem  to  be  in- 
volved in  those  cases  in  man  so  far  studied  clinically. 

Formaldehyde. — This  is  now  largely  used  as  an  antiseptic 
and    disinfectant,   generally  in   the  form  of  the    so-called 


572  TOXICOLOGY. 

"formalin,"  a  forty  per  cent,  solution  in  water.  Formal- 
dehyde is  a  gas  but  easily  changes  to  a  solid  (polymeric)  des- 
ignated paraform.  The  water  solution  is  irritating  and  in 
large  doses  will  produce  inflammation,  and  an  intoxication 
resembhng  that  of  alcohol.  The  antidote  to  it  when  in- 
haled is  the  cautious  inhalation  of  ammonia,  which  converts 
the  formaldehyde  into  a  harmless  substance.  When  for- 
maldehyde has  been  swallowed  the  stomach  should  be 
washed  out  thoroughly. 

ANESTHETICS. 

This  subdivision  of  Cerebral  Neurotics  comprises  those 
substances  that  display  their  power  chiefly  by  producing 
insensibility  to  pain  and  unconsciousness.  The  Anesthetics 
here  noticed  are  Ether  and  Chloroform.  Under  this  head 
also  it  will  be  convenient  to  speak  of  Chloral  Hydrate, 
although  its  action  differs  somewhat  from  that  of  the  others. 

POISONING   BY   ETHER,    CHLOROFORM,    AND   CHLORAL 
HYDRATE. 

Ether,  often  called,  erroneously,  sulphuric  ether,  is  a 
limpid,  colorless  liquid,  of  a  peculiar  odor,  and  hot,  pungent 
taste  ;  highly  volatile  and  inflammable  ;  sp.  gr.,  0.735  !  boils 
at  95°  F.;  burns  with  a  bright-yellow  flame,  depositing 
carbon  on  a  cold  porcelain  surface.  Sparingly  soluble  in 
water  ;  very  soluble  in  alcohol. 

Symptoms.  —  In  large  doses  it  produces  much  the  same 
effects  as  alcohol.  There  is  usually  a  short  period  of  de- 
lirious excitement,  followed  by  coma  and  other  symptoms 
of  narcotism,  similar  to  those  caused  by  alcohol. 

Post-mortem  Appearances. — On  account  of  its  less  solu- 
bility in  water,  ether  is  a  more  powerful  local  irritant  than 


CHLOROFORM SYMPTOMS.  573 

alcohol.  The  mucous  lining  of  the  stomach  and  duodenum 
of  a  dog  poisoned  with  ether  were  found  to  be  violently 
inflamed,  the  lungs  deeply  congested,  and  the  heart  full  of 
black  blood. 

The  inhalation  of  ether,'  as  is  well  known,  produces  rapid 
anesthesia.  Its  immediate  effect,  when  inhaled,  is  the  pro- 
duction of  a  transient  excitement ;  this  is  soon  followed, 
if  the  dose  be  sufficient,  by  stupor  and  insensibility.  This 
last  condition  may  be  prolonged  for  a  considerable  time  by 
continumg  the  inhalation.  Occasionally  the  excitement  is 
of  a  violent  character,  along  with  a  stubborn  resistance  to 
the  anesthetic  influence  ;  and,  again,  there  may  be  nausea 
and  vomiting. 

Analytic  Methods.  —  Ether  is  recognized  by  its  odor  and 
taste,  by  its  mode  of  combustion  and  volatility,  and  by  its 
action  on  sulphuric  acid  and  potassium  dichromate — the 
same  as  in  the  case  of  alcohol. 

From  organic  mixtures,  as,  e.  g.,  the  contents  of  the 
stomach,  it  is  to  be  separated  by  the  same  process  as  that 
described  for  Alcohol. 

Chloroform. — A  colorless,  hmpid  liquid,  very  volatile, 
giving  off  a  dense  vapor;  sp.  gr.,  1.497;  boiling  point, 
142°  F.  It  has  an  agreeable  characteristic  odor,  and  a 
smart,  pungent  taste.  It  is  nearly  insoluble  in  water,  in 
which  it  sinks  in  globules.  It  is  not  easily  inflammable.  It 
is  a  powerful  solvent  of  many  organic  substances,  the  alka- 
loids among  others.  At  a  red  heat,  its  vapor  is  decom- 
posed into  chlorin  and  hydrochloric  acid. 

Symptoms.  — A  large  dose  produces  local  irritation  in  the 
stomach,  with,  at  first,  a  general  stimulation  of  the  whole 
system,  soon  followed  by  a  decided  narcotism,  as  shown  by 


574  TOXICOLOGY. 

insensibility,  stupor,  convulsions,  dilated  pupils,  flushed 
face,  full  and  oppressed  pulse,  and  frothing  at  the  mouth. 
Cases  are  reported  where  the  pupils  were  contracted. 

Taylor  reports  a  case  where  a  boy,  aged  four  years,  died 
in  about  three  hours  after  swallowing  one  drachm  of  chlo- 
roform. It  has  often  caused  death  in  quantities  of  half  an 
ounce  and  upward. 

When  taken  by  inhalation  its  impression  is  more  speedy 
than  that'by  ether.  There  is,  moreover,  an  absence  of  the 
previous  excitement  attendant  on  the  latter,  the  patient 
almost  immediately  passing  into  insensibility.  It  appears 
to  act  as  a  depressant  from  the  first,  and  if  not  properly 
diluted  with  atmospheric  air,  it  may  rapidly  produce  death. 
In  one  case,  the  fatal  result  took  place  in  one  minute  after 
breathing  only  thirty  drops  in  the  state  of  vapor ;  and,  in 
another  instance,  only  fifteen  drops  proved  fatal  in  a  very 
short  time.  The  immediate  cause  of  death  from  chloro- 
form vapor,  appears  to  be,  in  the  majority  of  cases,  syn- 
cope, or  the  cessation  of  the  heart's  action  ;  in  others, 
asphyxia. 

Death  by  the  forced  inhalation  of  chloroform  was  sup- 
posed to  have  occurred  in  the  case  for  which  H.  H.  Mud- 
gett,  alias  H.  H.  Holmes,  was  tried,  convicted,  and  executed 
in  Philadelphia.  The  case  excited  widespread  interest  on 
account  of  the  number  of  crimes  of  various  grades  of 
which  the  prisoner  was  suspected.  The  crime  for  which  he 
was  tried  was  that  of  the  murder  of  a  man  with  whom  he 
had  arranged  to  defraud  an  insurance  company  by  the  sub- 
stitution of  a  corpse  pretending  to  be  that  of  the  insured. 
The  body  was  found  in  incipient  decomposition  several  days 
after  death.  There  was  some  chloroform  in  the  stomach 
find   also  some  evidence   of  an  attempt  to   set  fire  to  the 


CHLOROFORM ANALYTIC    METHODS.  5/5 

building.  It  is  believed  that  the  chloroform  was  introduced 
into  the  stomach  by  Holmes,  and  that  the  death  was  really 
produced  by  forced  inhalation  while  the  victim  was  decidedly 
intoxicated. 

Post-mortem  Appearances.  —  In  death  from  liquid  chloro- 
form, the  characteristic  odor  may  usually  be  recognized, 
together  with  slow  putrefaction  of  the  body  and  persistent 
rigor  mortis.  There  is  also  much  irritation  of  the  stomach 
sometimes  accompanied  with  softening,  and  in  one  case  with 
ulceration. 

In  death  from  inhalation  there  is  very  often  no  lesion 
discoverable.  At  times  there  will  be  found  considerable 
congestion  of  the  lungs  and  bronchial  tubes,  and  likewise 
of  the  vessels  of  the  brain,  together  with  a  dark  and  fluid 
condition  of  the  blood. 

Treatment.  —  In  poisoning  by  liquid  chloroform,  the 
stomach  should  be  immediately  evacuated  by  the  stomach- 
pump,  or  by  a  prompt  emetic,  and  stimulants  afterward 
administered.  If  inhalation  has  caused  the  danger,  the 
chloroform  should  be  immediately  withdrawn  and  fresh 
air  freely  admitted ;  cold  affusion  should  be  applied  to  the 
face  and  chest ;  the  inversion  of  the  body  (holding  it  sus- 
pended by  the  feet)  is  often  successful.  The  tongue  should 
at  once  be  drawn  out  of  the  mouth,  to  facilitate  respiration  ; 
artificial  respiration  and  the  direct  galvanic  current  should 
also  be  practiced. 

Analytic  Methods. — The  odor  will  usually  be  present  in 
organic  mixtures,  such  as  the  contents  of  the  stomach. 
These  should  be  distilled  on  a  water-bath,  and  the  distillate 
re-distilled  along  with  calcium  chlorid,  and  the  product 
subjected  to  the  proper  tests,  as  odor,  taste,  solubility, 
etc. 


576  TOXICOLOGY. 

Toxicologic  Examination. — The  contents  of  the  stomach, 
or  the  organs  properly  divided,  along  with  distilled  water, 
should  be  put  into  a  large  flask,  the  neck  of  which  is  fitted 
with  a  cork  perforated  to  contain  a  hard  glass  tube,  bent  at 
right  angles,  and  from  twelve  to  fifteen  inches  long.  The 
flask  is  gradually  heated  on  a  water-bath,  and  at  the  same 
time  the  middle  of  the  horizontal  tube  is  heated  red-hot  by 
a  Bunsen  flame.  At  a  red  heat,  chloroform  is  decomposed 
into  chlorin  and  hydrochloric  acid.  A  slip  of  moistened 
litmus  paper,  placed  at  the  mouth  of  the  tube,  is  first  red- 
dened and  then  bleached ;  starch  paper,  wetted  with  potas- 
sium iodid,  is  rendered  blue ;  and  if  the  end  of  the  tube  be 
made  to  dip  into  a  solution  of  silver  nitrate,  white  silver 
chlorid  will  be  precipitated.  The  absence  of  any  free  hydro- 
chloric acid  in  the  orignal  material  should  be  first  insured 
by  the  addition  of  sodium  carbonate. 

It  is  important  to  remember  that  if  chloral  hydrate  had 
been  taken  by  the  patient  just  previous  to  death,  and  the 
alkali  be  added  to  the  mixture  for  examination,  the  chloral 
will  be  decomposed  into  chloroform  and  produce  all  the 
above  reactions. 

There  are  certain  important  questions  connected  with  the 
administration  of  chloroform  as  an  anesthetic,  with  which 
the  physician  should  be  familiar,  such  as  whether  persons 
asleep  may  be  chloroformed  without  their  being  awakened 
and  thus  robbed  or  otherwise  maltreated.  It  has  been  as- 
certained by  direct  experiment  that  this  effect  can  be  pro- 
duced if  the  sleep  is  profound. 

Chloral  Hydrate.  —  A  solid,  crystalline  body,  having  a 
peculiar,  disagreeable,  pungent  taste  and  smell ;  tolerably 
soluble  in  water  ;  not  inflammable.  Sodium  hydroxid  added 
to  its  boihng  aqueous  solution  instantly  converts  it  into 


CHLORAL    HYDRATE ANALYTIC    METHODS.  57/ 

chloroform  and  potassium  formate.  It  reduces  copper 
hydroxid  in  a  manner  similar  to  glucose. 

Syjnptoins.  —  Chloral  hydrate  has  been  much  used  as  a 
hypnotic.  It  is  not  infrequently  employed  in  "  drugging  " 
liquor  to  assist  in  robbery  or  rape.  Its  indiscriminate  use 
has  led  to  many  fatal  results.  There  appears  to  be  a  ten- 
dency to  accumulation,  and  a  sudden  and  dangerous  action 
of  the  drug.  In  moderate  doses  it  acts  as  a  hypnotic  ;  in 
large  doses  it  produces  a  powerful  depressant  action  on 
the  ganglia  at  the  base  of  the  brain  and  on  the  spinal  cord, 
causing  feeble  action  of  the  heart  and  lungs. 

A  full  dose  generally  occasions  deep  sleep,  followed,  if 
the  quantity  be  very  large,  by  fatal  coma.  The  pulse  is 
usually  very  slow  and  feeble  ;  the  face  pale ;  respiration 
slow,  the  heart  being  ultimately  arrested  in  diastole. 

Much  discrepancy  of  opinion  exists  as  regards  the  fatal 
dose  of  chloral  hydrate.  Numerous  instances  are  reported 
where  ordinaiy  doses  of  thirty  grains  have  occasioned 
alarming  and  even  fatal  effects ;  while,  on  the  other  hand, 
enormous  quantities  —  over  an  ounce  —  have  been  swallowed 
with  comparative  impunity.  As  a  rule,  thirty  grains  may 
be  considered  as  a  maximum  dose,  and  not  to  be  repeated 
oftener  than  every  six  or  eight  hours. 

Picrotoxiii  has  been  used  successfully  as  an  antidote  to 
chloral. 

Analytic  Methods.  —  The  principle  involved  is  the  con- 
version of  the  chloral  into  chloroform,  through  the  agency 
of  an  alkali,  as  explained  above.  The  solid  matters,  properly 
divided,  should  be  diluted  with  distilled  water,  and  rendered 
alkaline  by  sodium  hydroxid,  and  heated  in  a  flask,  and  the 
experiment  conducted  after  the  manner  described  under  the 
head  of  Chloroform, 


578  TOXICOLOGY. 

Methyl  Bromid.  —  Three  cases  of  probable  poisoning  by 
methyl  bromid  have  been  reported  by  Schuler.  The  chief 
symptoms  were  unconsciousness  and  epileptiform  convul- 
sions. Jaquet  has  reported  cases  undoubted  as  to  cause, 
having  arisen  during  a  brief  inhalation  of  the  material.  The 
symptoms  were  giddiness,  disturbance  of  vision  and  unsteadi- 
ness of  gait  similar  to  that  due  to  alcohol.  In  one  of  the 
cases  the  condition  continued  with  some  variation  for  eight 
days  ;  in  the  other  case  it  slowly  disappeared  during  five 
weeks  and  left  a  listlessness  and  tendency  to  dizziness. 
Experiments  on  rabbits  showed  loss  of  muscular  power, 
diminished  frequency  of  respiration,  lowered  blood  pressure, 
and  death  in  convulsions.  Jaquet  calls  attention  to  the 
similarity  of  the  cases  to  one  of  poisoning  by  methyl  iodid. 
On  the  other  hand,  they  are  distinguished  from  poisoning 
by  bromoform  and  ethyl  bromid  by  the  duration  of  the 
symptoms.  Ethyl  bromid  acts  only  during  the  inhalation, 
bromoform  shortly  after  the  ingestion  and  the  effects  soon 
disappear,  while  as  noted  above  the  action  of  methyl  bro- 
mid continues  for  a  long  time  after  the  ingestion  of  the  drug. 
The  above  cases  are  interesting  in  connection  with  the 
recently  recognized  toxic  effect  of  methyl  alcohol.  It  is 
still  a  matter  of  uncertainty  whether  these  effects  are  wholly 
due  to  the  methyl  compound  or  to  impurities.  The  source 
of  the  methyl  bromid  is  not  given,  but  it  was  probably 
derived  from  the  commercial  alcohol,  and  may,  therefore, 
have  contained  empyreumatic  products. 

SPINAL   NEUROTICS. 

Nux  Vomica  is  by  far  the  most  important  poison  included 
under  this  order  of  Neurotics.  It  is  the  seed  of  the  Strych- 
nos  mix  vomica,  a  tree  growing  in  India.     Several  seeds  are 


STRYCHNIN SYMPTOMS.  579 

enclosed  in  a  yellow  fruit.  The  seed  is  a  circular  disk,  an 
inch  or  less  in  diameter,  concavo-convex,  of  a  light-brown 
color,  covered  over  with  short,  whitish,  silky  hairs,  ex- 
tremely tough  and  difficult  to  pulverize  ;  excessively  bitter 
to  the  taste.  Several  seeds  are  enclosed  in  a  single  fruit. 
They  contain  two  powerfully  poisonous  alkaloids — strychnin 
and  briicin,  and  several  other  alkaloids  of  less  activity. 
The  amount  of  contained  strychnin  is  estimated  at  one  half 
to  one  per  cent,  of  the  seed. 

The  smallest  fatal  dose  of  nux  vomica  is  thirty  grains 
(about  the  weight  of  one  seed),  and  three  grains  of  the  alco- 
holic extract.  The  symptoms,  treatment,  etc.,  are  precisely 
similar  to  those  described  under  the  head  of  Strychnin. 

Strychnin.  —  Exists  in  several  species  of  Stryclinos  be- 
sides the  S.  nux  vomica  ;  it  is  the  poisonous  principle  of  the 
S.  Ignatia,  or  St.  Ignatius'  Bean ;  it  is  also  found  in  False 
Angnstura  Bark. 

Strychnin  is  a  very  frequent  cause  of  poisoning,  whether 
accidental,  homicidal,  or  suicidal.  The  celebrated  Palmer 
case,  which  occurred  in  England  in  1856,  brought  it  promi- 
nently before  toxicologists. 

Symptoms.  —  These  vary  somewhat  in  the  time  of  their 
appearances,  according  to  the  form  of  the  administration. 
The  first  effect  is  a  feeling  of  restlessness  and  general  un- 
easiness, with  a  sense  of  impending  suffocation  and  want  of 
air.  Very  soon  twitching  of  the  muscles  and  jerking  of  the 
limbs  and  head  comes  on  ;  these  are  followed  suddenly  by 
a  violent  tetanic  convulsion,  which  pervades  the  whole 
body ;  the  legs  are  stretched  out  stiffly  and  widely  sepa- 
rated ;  the  feet  arched  and  usually  turned  in  ;  the  arms  are 
flexed  and  tightly  drawn  across  the  chest ;  the  head  is  bent 
back  rigidly,  and  the  whole  body  flexed  backward  so  as  to 


5  8o  TOXICOLOGY. 

rest  upon  the  head  and  heels  (opisthotonos).  As  the  mus- 
cles of  the  chest  and  abdomen  are  spasmodically  contracted, 
the  respiratory  movements  become  arrested ;  the  face  is 
livid  and  congested,  especially  around  the  lips  ;  the  eyes 
prominent  and  staring ;  pupils  widely  dilated ;  the  muscles 
about  the  mouth  contracted  so  as  to  produce  the  expression 
denominated  7'isus  sardoniciis ;  the  pulse  is  very  rapid  and 
feeble.  Sometimes  there  is  foaming  at  the  mouth,  and  the 
froth  may  even  be  tinged  with  blood.  The  intellect  remains 
perfectly  clear,  while  the  patient  is  experiencing  the  most 
intense  suffering,  gasping  for  breath,  and  seeking  in  vain  for 
relief  in  asking  to  be  turned  over,  or  moved,  or  held.  The 
jaws  are  not  always  fixed  during  a  paroxysm  ;  the  patient 
may  hence  be  able  to  speak ;  and  as  there  is  often  great 
thirst,  he  may  ask  for  water,  but  the  effort  to  swallow  is 
apt  to  intensify  the  spasm,  as  in  hydrophobia,  and  cause 
him  to  bite  upon  the  vessel. 

The  paroxysm  may  last  from  half  a  minute  to  several 
minutes,  when  a  complete  relaxation  occurs  ;  the  patient 
now  feels  exhausted  and  is  bathed  in  perspiration ;  the 
pupils  may  now  become  contracted.  In  a  short  time,  vary- 
ing from  a  few  minutes  to  half  an  hour,  the  fit  returns.  It 
is  usually  preceded  by  an  apprehension  of  the  impending 
danger,  the  special  senses  being  exceedingly  acute.  The 
spasm  may  be  brought  on  by  the  slightest  cause,  as  the 
opening  of  a  door,  a  sudden  noise,  a  current  of  air,  or  an 
attempt  to  move.  In  some  instances  the  violence  of  the 
spasm  is  so  great  as  to  jerk  the  patient  out  of  bed.  Should 
the  case  prove  fatal,  the  paroxysms  increase  in  frequency 
and  violence,  until  at  last  death  ensues,  either  from  asphyxia, 
the  patient  dying  in  a  paroxysm,  or  from  sheer  exhaustion 
during  an  interval. 


STRYCHNIN SYMPTOMS.  58 1 

Although  the  intelhgence  continues  unimpaired  during 
the  progress  of  the  case,  it  may  happen  that  it  becomes 
clouded  just  before  the  fatal  termination,  in  consequence  of 
the  asphyxia  causing  a  deficiency  of  aeration  of  the  blood, 
and  the  consequent  accumulation  of  carbon  dioxid.  As  a 
rule,  when  the  paroxysms  are  once  established,  they  pro- 
gress either  to  fatal  termination  or  toward  a  cure  within 
two  hours  of  the  seizure,  though  there  may  be  some  excep- 
tions to  this  rule. 

The  time  of  the  first  manifestation  of  the  symptoms  varies 
from  a  few  minutes  to  some  hours  ;  the  average  is  fifteen 
minutes  to  half  an  hour.  Dr.  G.  H.  Barker  has  reported 
the  case  of  a  young,  healthy  woman,  who  took  six  grains 
of  strychnin,  in  whom  violent  symptoms  were  manifested  in 
three  minutes,  and  death  took  place  in  convulsion  in  half 
an  hour.  In  Dr.  Warner's  case,  who  took,  it  is  supposed, 
less  than  half  a  grain,  the  symptoms  appeared  in  five 
minutes  and  death  occurred  in  about  eighteen  minutes. 
In  another  case  convulsions  came  on  in  five  minutes.  On 
the  other  hand,  this  interval  may  be  protracted  for  several 
hours.  Dr.  Anderson  reports  the  case  of  a  man  who  took 
by  mistake  three  and  a  half  grains  of  strychnin,  and  ex- 
perienced no  particular  symptoms  for  two  hours  and  a  half, 
when  he  suddenly  fell  backward  ;  but  on  being  raised  he 
was  able  to  walk  home  and  finally  recovered.  Undoubtedly 
the  form  in  which  the  poison  is  administered  has  much  to 
do  with  the  rapid  development  of  the  symptoms.  This  is 
shown  in  a  case  cited  by  Taylor  of  a  boy,  aged  twelve  years, 
who  swallowed  a  pill  containing  three  grains  of  strychnin, 
in  whom  no  symptoms  were  manifested  for  three  hours  ; 
they  then  set  in  with  their  usual  violence  and  death  took 
place  in  ten  minutes.      This  pill  had  been  prepared  with 


582  TOXICOLOGY. 

mucilage  eight  months  before,  and  was  consequently  hard 
and  difficult  to  dissolve.  In  the  Palmer  case,  Cook  took 
two  pills  containing  strychnin.  No  symptoms  were  observed 
for  an  hour  and  a  quarter,  after  which  death  occurred 
in  twenty  minutes. 

There  are  cases  in  which  the  unusual  delay  cannot  be 
thus  accounted  for,  but  in  which  it  must  be  referred  to 
some  individual  peculiarity  of  the  patient.  Wormley  men- 
tions a  case  where  the  remarkable  postponement  of  the 
symptoms  for  twelve  hours  appeared  to  be  owing  to  the 
effects  of  a  large  dose  of  opium  that  had  been  taken  simul- 
taneously. Three  grains  of  strychnin,  a  drachm  of  opium, 
and  an  indefinite  quantity  of  quinin  were  taken  at  the  same 
time.  Other  equally  remarkable  instances  might  be  ad- 
duced, showing  the  same  apparent  antagonism  between 
strychnin  and  opium.  Nevertheless,  in  some  experiments 
with  strychnin  and  morphin  combined,  made  on  animals  by 
Dr.  Reese,  the  latter  poison,  so  far  from  antagonizing  the 
former,  appeared  rather  to  intensify  it. 

■The  subcutaneous  injection  of  strychnin,  as  also  its  ex- 
ternal application  to  a  healthy  mucous  surface,  produces  a 
still  more  speedy  manifestation  of  its  peculiar  symptoms. 
Some  clinical  experiments  of  Dr.  Chisholm,  of  Baltimore, 
made  on  amaurotic  patients,  would  seem  to  show  that  the 
human  system  acquires  a  tolerance  of  stiychnin. 

Fatal  Dose.  —  There  is  great  difference  as  to  the  suscep- 
tibility to  the  action  of  strychnin.  The  average  medicinal 
dose  is  about  the  one  sixteenth  of  a  grain,  though  it  is  cus- 
tomary to  commence  with  a  smaller  quantity.  The  above 
dose  has  proved  fatal  to  a  child  between  two  and  three 
years  old.  Dr.  G.  B.  Wood  mentions  the  case  of  a  lady 
who  was  thrown  into  alarming  spasms  by  one  twelfth  of  a 


STRYCHNIN FATAL     PERIOD.  583 

grain.  Dr.  Reese  had  personal  knowledge  of  a  case  of  a 
gentleman  who  had  decided  spasms  after  taking  about  one 
twentieth  of  a  grain.  In  Philadelphia  recently  severe 
symptoms  fallowed  the  taking  of  one  quarter  of  a  grain  of 
strychnin  sulphate  by  an  adult  woman,  but  a  fatal  result 
was  avoided. 

The 'smallest  fatal  result  for  an  adult  recorded  is  half  a 
grain,  which  proved  fatal  to  Dr.  Warner.  Dr.  Ogston,  re- 
ports a  case  where  three  quarters  of  a  grain  destroyed  a  man 
in  three  quarters  of  an  hour.  A  fatal  dose  for  an  adult  may 
be  stated  to  be  half  a  grain  to  one  grain. 

On  the  other  hand,  numerous  instances  are  recorded  of 
recoveries  after  enormous  doses  of  this  poison — ten,  twelve, 
and  even  forty  grains.  In  all  these  cases  early  vomiting  was 
produced,  which,  doubtless,  removed  the  strychnin  before 
it  was  absorbed  to  a  fatal  extent.  Besides,  it  is  quite  pos- 
sible that  the  poison  was  not  of  full  strength. 

Fatal  Period.  —  This,  like  the  fatal  dose,  is  liable  to  con- 
siderable variation.  Dr.  Warner's  case  terminated  fatally 
in  eighteen  minutes.  Taylor  mentions  two  cases  in  which 
death  occurred  in  ten  and  fifteen  minutes  respectively  ;  in 
another  case  in  five  minutes  ;  in  two  others  in  thirty  minutes 
each. 

On  the  other  hand,  life  has  been  prolonged,  even  after 
large  doses,  for  several  hours.  In  Cook's  case,  death  oc- 
curred in  an  hour  and  a  quarter  after  swallowing  the  pill. 
In  the  case  of  a  woman  examined  by  Dr.  Reese,  death  did 
not  occur  for  six  hours  after  swallowing  about  six  grains  of 
strychnin  ;  morphin,  however,  had  previously  been  admin- 
istered. Sir  R.  Christison  reports  a  case  in  which  a  man 
died  in  fifteen  minutes  after  swallowing  a  dose  of  mix 
vomica. 


584  TOXICOLOGY. 

Treatment.  —  Prompt  and  free  emesis  is  of  the  greatest 
importance.  Copious  draughts  of  warm  mustard  water,  or 
a  mixture  of  ipecac  and  zinc  sulphate  should  be  given. 
The  stomach-pump  may  be  used  if  the  spasm- of  the  jaws 
will  permit.  Chloroform  by  inhalation  appears  to  have  been 
attended  with  the  happiest  results.  The  patient  should  be 
constantly  kept  under  its  influence,  carefully  watching  its 
effects.  Potassium  bromid  has  also  been  given  with  the 
best  results — sixty  to  eighty  grains  every  hour  or  half  hour. 
Chloral  hydrate  has  also  proved  an  efficient  remedy  in  several 
cases,  and  amyl  nitrate  has  been  recommended,  from  its 
known  physiological  effects.  Atropin  has  also  proved  effi- 
cacious as  an  antidote  in  a  case  when  chloroform  failed, 
and  when  the  paroxysms  were  very  severe. 

Two  new  remedies  have  lately  been  suggested  as  decid- 
edly antagonistic  to  strychnin  —  paraldehyd  and  urethrane, 
both  powerful  hypnotics ;  the  former  by  Cervello  and 
Bokai,  the  latter  by  Dr.  Coze.  Urethane  should  be  given 
in  large  doses,  from  four  to  six  grains,  as  an  antidote.  C. 
G.  Williams  suggests  lutidin  as  a  valuable  antidote.  He 
found  that  when  injected  into  frogs,  after  a  lethal  dose  of 
strychnin  had  been  administered,  it  arrested  the  convul- 
sions ;  and  if  given  first,  it  prevented  them. 

Dr.  Reese  experimented  on  dogs  that  were  poisoned 
with  strychnin,  tobacco,  iodin,  ferric  chlorid,  and  aconite  ;  but 
in  no  case  did  any  of  these  agents  exhibit  antidotal  powers. 

Post-mortem  Appearances.  —  These  are  by  no  means  char- 
acteristic, nor  are  they  always  similar.  Probably  the 
lesions  most  commonly  observed  are  congestion  of  the 
brain  and  membranes,  and  of  the  spinal  cord,  with  engorge- 
ment of  the  lungs  and  a  dark  and  fluid  condition  of  the 
blood.     The  heart  is  sometimes  contracted  and  empty,  and 


STRYCHNIN DIAGNOSIS.  5^5 

at  others  full  of  blood.  The  rigor  mortis  is  usually  pro- 
longed ;  in  one  case  we  found  it  existing  six  weeks  after 
death.  There  is  also  frequently  noticed  a  livid  appearance 
about  the  mouth  and  tongue,  and  also  of  the  fingers  and 
toes.  It  should  be  remembered  that  certain  disorders  of 
the  brain  and  spinal  cord,  attended  with  tetanic  convulsions, 
will  leave  precisely  similar  lesions  to  those  just  referred  to 
as  following  death  by  strychnin. 

Diagnosis.  —  The  importance  of  a  clear  diagnosis  in  a  case 
of  strychnin  poisoning  cannot  be  too  strongly  urged,  inas- 
much as  there  may  be  in  such  a  case  a  complete  absence  of 
all  chemical  proof  In  the  celebrated  Palmer  case  this 
question  was  most  thoroughly  sifted  on  both  sides.  In- 
deed, this  very  case  affords  an  apt  illustration  of  just  the 
sort  of  difficulties  that  present  themselves  in  forming  a  cor- 
rect appreciation  of  the  symptoms.  In  the  Palmer  case  the 
defense  brought  forward  an  immense  array  of  diseases, 
which,  as  remarked  by  Tardieu,  "  have  but  a  faint  resem- 
blance to,  and  often  a  complete  diversity,  from,  the  char- 
acteristic phenomena  of  strychnin  poisoning."  The  only 
disease  whose  symptoms  can  possibly  be  confounded  with 
those  occasioned  by  strychnin  is  tetanus  in  its  varieties  of 
idiopathic,  traumatic,  and  hysterical,  and  possibly  some 
forms  of  epilepsy. 

If  the  expert  were  obliged  to  decide  solely  from  the  con- 
vulsions —  apart  from  its  mode  of  invasion  and  seizure,  its 
duration  and  termination,  the  condition  of  the  intervals  be- 
tween the  paroxysms,  in  fine,  apart  from  the  whole  history 
of  the  attack  —  he  might  probably  be  unable  to  discriminate 
between  a  case  of  strychnin  poisoning  and  one  of  tetanus  ; 
but  where  a  careful  examination  of  all  these  attending  cir- 
cumstances has  been  instituted  there   can   be  no  possible 

49 


586  TOXICOLOGY. 

difficulty  in  reaching  a  satisfactory  conclusion.  The  dis- 
tinctive characters  are  the  following:  (i)  In  traumatic 
tetanus  the  history  of  the  case,  as  being  connected  with 
some  injury,  such  as  a  lacerated,  contused,  or  punctured 
wound,  involving  tendons,  nerves,  and  fascia,  will  always 
throw  sufficient  light  on  the  case  to  admit  of  an  easy  diag- 
nosis ;  although  it  must  not  be  forgotten  that  the  most 
trifling  injury,  such  as  the  insertion  of  a  splinter  of  wood 
beneath  the  fascia,  and  which  may  have  entirely  escaped 
recollection,  may,  after  the  lapse  of  several  days,  give  rise 
to  this  frightful  disorder ;  and  such  a  case  might  be  mis- 
taken for  idiopathic  tetanus.  But  as  regards  the  latter 
form  of  the  disorder,  besides  its  extreme  rarity  in  temperate 
climates,  its  mode  of  invasion  (as  likewise  that  of  traumatic 
tetanus),  the  duration  of  the  attack  and  the  character  of  the 
symptoms,  are  entirely  different  from  those  of  strychnin  poi- 
soning. In  the  former  there  are  always  manifested  certain 
prodromes,  such  as  chills,  faintness,  insomnia,  headache, 
vertigo,  and  painful  tension  about  the  diaphragm,  which 
may  last  for  several  days.  These,  of  course,  are  entirely 
wanting  in  poisoning  by  strychnin,  and  they  never  can  be 
mistaken  for  the  general  uneasiness  with  precedes  for  only 
a  few  minutes  the  sudden  outburst  of  convulsions  in  the 
case  of  the  poison.  (2)  The  first  symptoms  in  tetanus  are 
a  painful  stiffness  of  the  neck  and  jaws,  with  a  difficulty  of 
moving  the  head  ;  after  this  there  is  a  gradual  spreading  of 
the  rigidity  over  the  muscles  of  the  other  parts  of  the  body, 
usually  the  trunk  first,  then  the  limbs.  In  some  instances 
the  contractions  reach  their  greatest  intensity  in  the  course 
of  a  few  hours  ;  in  others,  several  days  may  elapse.  To 
contrast  this  with  a  case  of  strychnin  poisoning  :  in  the 
latter,  instead  of  the  gradual  invasion  of  the  rigid  spasms. 


STRYCHNIN DIAGNOSIS.  58/ 

commencing  in  the  neck  or  jaws,  there  is  a  sudden  tetanic 
seizure  of  all  the  muscles  of  the  body  simultaneously,  pro- 
ducing the  violent  jerking  of  the  body  and  the  arching  of 
it  backward.  Again,  while  the  muscles  of  the  neck  and 
jaws  are  never  the  first  to  be  affected  by  strychnin,  but  are 
often  the  last,  the  reverse  is  the  case  in  the  disease — the 
trismus  being  the  first  indication  of  its  approach.  (3)  A 
third  distinction  is  founded  on  the  progress  of  the  two 
cases  ;  while  the  violent  paroxysm  produced  by  strychnin 
lasts  only  from  half  a  minute  to  one  or  two  minutes,  and  is 
succeeded  by  a  complete  relaxation,  in  tetanus,  on  the  con- 
trary, the  rigidity  is  generally  permanent,  or  if  there  be  any 
remissions  these  never  exhibit  the  character  of  the  complete 
intermissions  characterizing  the  action  of  strychnin.  (4) 
The  termination  of  the  cases  is  widely  different ;  idiopathic 
tetanus  never  terminates  fatally  in  two  or  three  hours,  but 
usually  several  days  elapse  ;  while  in  the  case  of  the  poison 
death  often  occurs  within  half  an  hour  to  two  hours.  Some 
cases  of  traumatic  tetanus  are  reported  which  proved  fatal 
within  twelve  hours  ;  and  one  remarkable  case,  quoted  by 
Watson,  of  a  negro  who  lacerated  his  thumb  by  the  acci- 
dental fracture  of  a  china  dish  ;  he  was  seized  with  convul- 
sions almost  instantly  and  died  with  tetanic  symptoms  in 
a  quarter  of  an  hour.  This  can  hardly  be  a  case  of  true 
tetanus  ;  indeed,  it  seems  unlikely  that  the  symptoms  were 
caused  by  the  accident  mentioned. 

As  regards  the  hysterical  form  of  tetanus,  although  its 
very  existence  has  been  denied  by  some,  especially  in  the 
male,  it  is  admitted  by  numerous  competent  authorities  ; 
and,  inasmuch  as  among  other  forms  it  may  assume  that  of 
tetanic  spasms,  and  might  occasion  doubt  under  peculiar 
circumstances,  the  examiner  should  ascertain  the  previous 


588  TOXICOLOGY. 

history  of  the  case,  which  will  serve  to  clear  up  the 
diagnosis. 

In  relation  to  epilepsy  there  ought  to  be  no  difficulty  in 
the  diagnosis ;  the  mode  of  seizure,  the  unconsciousness, 
and  the  peculiar  clonic  movements  are  Avholly  different 
from  the  characteristic  tetanic  spasms  of  strychnin  poison- 
ing. Again,  the  deep  stupor  which  terminates  an  epileptic 
attack  contrasts  widely  with  the  complete  relaxation  and 
perfect  intelligence  that  follow  the  strychnin  spasm. 

Analytic  Methods.  —  Stiychnin  occurs  in  the  form  of  a 
white  powder,  and  also  in  crystals,  usually  prismatic.  It  is 
almost  insoluble  in  water — one  part  in  seven  or  eight  thou- 
sand. Absolute  alcohol  dissolves  one  part  in  about  two 
hundred  ;  amylic  alcohol,  one  in  one  hundred  and  tv/enty ; 
pure  ether,  one  in  about  fourteen  hundred ;  commercial 
ether,  one  in  about  one  thousand ;  chloroform,  one  part 
in  eight.  It  is  insoluble  in  the  fixed  alkalies,  and  veiy 
sparingly  so  in  ammonium  hydroxid.  The  salts  of  strych- 
nin are  very  soluble  in  water  and  alcohol,  but  very  slightly 
so  in  ether.  The  taste  is  intensely  and  permanently  bitter. 
This  is  one  of  its  characteristic  qualities.  In  fact,  it  is  the 
bitterest  substance  known.  As  the  result  of  numerous  ex- 
periments. Dr.  Reese  found  distinct  bitterness  yielded  by  a 
solution  of  one  grain  of  strychnin  in  several  gallons  of  water. 
This  bitter  taste  is  one  of  the  strongest  corroborative  proofs 
of  the  presence  of  strychnin.  Unless  the  ultimate  extract 
obtained  by  the  manipulation  has  a  bitter  taste,  one  need 
not  expect  to  prove  the  presence  of  the  poison  by  the  usual 
chemical  tests.  The  mere  bitterness  is  not  of  itself  evidence 
of  strychnin,  since  this  quality  pertains  to  numerous  other 
substances,  such  as  morphin,  quinin,  aloes,  colocynth,  and 
picrotoxin. 


STRYCHNIN COLOR   TEST.  589 

The  strong  mineral  acids  produce  no  coloration  with 
strychnin,  provided  the  latter  is  pure  ;  if  it  contains  brucin 
it  will  impart  a  reddish  color  to  nitric  acid.  Heated  on 
porcelain,  it  melts  slowly  into  a  brown  liquid,  and  is  de- 
composed, giving  off  dense  white  fumes  and  leaving  car- 
bon. It  may  be  sublimed  by  heat,  depositing  feather-like 
crystals  on  a  cold  glass  surface. 

I.  The  Color  Test. — This  is  so  named  on  account  of  the 
beautiful  succession  or  play  of  colors  that  is  developed  by 
it.  It  consists  in  the  application  of  a  drop  of  pure  sulphuric 
acid  to  a  small  fragment  of  strychnin  on  a  white  porcelain 
surface  or  on  a  watch-glass  over  white  paper.  If  the 
strychnin  be  perfectly  pure  it  will  dissolve  in  the  acid  with- 
out any  coloration.  If  now  a  fragment  of  potassium  dichro- 
mate,  manganese  dioxid,  lead  dioxid,  potassium  ferricyanid, 
or  potassium  permanganate  be  stirred  in  contact  with  the 
solution  by  means  of  a  pointed  glass  rod,  a  play  of  colors 
is  instantly  manifested.  At  first  it  is  of  a  rich,  deep  blue ; 
this  soon  passes  into  violet  and  purple,  which,  in  its  turn, 
fades  into  a  pink,  then  into  a  red,  and  finally  into  a  dirty 
green. 

The  relative  duration  of  these  shades  of  color  depends  on 
the  quantity  of  strychnin  operated  on,  and  also  on  the  rela- 
tive amounts  of  acid  and  the  other  substance.  Thus,  if  the 
amount  of  strychnin  be  extremely  minute,  the  blue  color 
may  flash  out  but  for  a  moment,  leaving  only  the  violet  or 
purple,  which  quickly  passes  into  the  red. 

The  principle  involved  in  the  color-test  is  the  action 
of  oxygen  (developed  by  the  sulphuric  acid  on  the  various 
oxidizing  substances  above  named)  on  the  strychnin.  Allen 
states  that  manganese  dioxid  is  the  best  substance  to  use  in 
this  test. 


500  TOXICOLOGY. 

It  is  very  important  to  have  clear  and  definite  ideas  about 
this  color-test  for  strychnin.  It  is  not  the  mere  production 
of  a  blue  color  that  is  of  diagnostic  value,  for  this  might 
result  from  the  application  of  potassium  permanganate  to 
various  organic  bodies  in  the  absence  of  strychnin  ;  but  it 
consists  in  the  regular  succession  of  colors  —  from  blue  to 
violet,  pink,  and  red,  the  last  continuing  for  some  time  and 
ultimately  changing  to  a  dirty  green.  So  far  as  is  known, 
strychnin  is  the  only  substance  that  answers  to  the  above 
requisition.  There  are  others  that  react  somewhat  similarly, 
which  will  be  noticed  hereafter. 

The  exceeding  delicacy  of  the  color-test  deserves  special 
notice.  If  the  strychnin  be  perfectly  pure  and  the  manipu- 
lation be  properly  performed,  so  minute  a  quantity  as  the 
one  millionth  of  a  grain  can  be  detected.  Much  depends 
on  the  manner  of  the  experiment.  Minute  quantities  of 
strychnin  are  best  obtained  by  first  making  a  solution  of  the 
alkaloid  in  pure  water,  with  the  addition  of  acetic  acid  of 
a  definite  strength.  This  may  readily  be  reduced  by  the 
addition  of  more  water.  Fractional  portions  of  the  solution 
may  be  obtained  by  using  a  pipette  drawn  out  to  a  capillary 
point,  which  will  deposit  minute  droplets  on  a  warmed  clean 
porcelain  surface.  The  object  here  is  to  concentrate  the 
quantity  to  be  experimented  upon  into  as  small  a  space  as 
possible.  The  drop  should  then  be  carefully  evaporated  to 
dryness.  A  small  drop  of  pure  concentrated  sulphuric  acid 
is  then  applied  to  the  deposit  by  means  of  a  finely-pointed 
glass  rod,  and  then  a  minute  amount  of  manganese  dioxid 
(or  one  of  the  other  oxidizing  bodies)  is  placed  alongside  of 
the  acid  solution,  and  then,  by  means  of  the  rod,  it  is  drawn 
through  the  solution  and  gently  stirred  into  it. 

Interferences. — As  above  mentioned,  the  color-test  prop- 


STRYCHNIN INTERFERENCE.  59 1 

erly  applied  will  detect  exceedingly  minute  portions  of  pure 
stiychnin ;  but  there  are  many  organic  substances  whose 
presence  will  considerably  modify  and  even  completely  dis- 
guise this  test.  This  fact  has  been  known  to  chemists  since 
1850,  when  it  was  first  announced  by  Brieger.  His  results 
have  been  confirmed,  and  the  list  of  interfering  bodies  has 
been  extended  by  subsequent  experimenters.  According 
to  Lyman,  potassium  permanganate  is  the  only  reagent  that 
will  develop  the  color-test  with  stiychnin  when  the  latter  is 
mixed  with  either  morphin  or  quinin  in  excess.  The  most 
important  of  these  interferences,  considered  medico-legally, 
is  probably  morphin,  inasmuch  as  this  substance  might  be 
likely  to  be  given  to  allay  the  severity  of  the  strychnin 
spasms,  and  would  consequently  be  associated  with  the 
strychnin  extracted  from  the  body  after  death.  A  large 
number  of  experiments  made  by  Dr.  Reese  clearly  confirm 
the  fact  of  the  interference  of  morphin  with  the  usual  color- 
test  for  strychnin,  both  in  the  pure  state  and  when  mixed 
with  organic  matters.  The  important  point  to  establish  was 
that  this  interference  was  especially  obvious  when  both  al- 
kaloids were  present  in  only  very  minute  quantities,  such 
as  the  one  hundredth  of  a  grain  or  less ;  in  such  cases  the 
strychnin  is  not  discoverable  by  the  color-test  if  the  mor- 
phin is  in  excess,  and  is  barely  manifested  when  in  equal 
quantity.  One  experiment  by  Dr.  Reese  will  be  men- 
tioned :  A  cat  was  poisoned  "with  one  twentieth  of  a  grain 
of  strychnin  and  one  tenth  of  a  grain  of  morphin.  The 
ultimate  extract  obtained  from  the  stomach  by  Stas'  process 
entirely  failed  to  yield  the  color-test,  although  the  bitterness 
of  the  extract  and  the  fact  that  its  solution  produced  the 
characteristic  tetanic  convulsions  in  a  number  of  frogs  dis- 
tinctly proved  the  existence  of  strychnin." 


592  TOXICOLOGY. 

Admitting,  then,  the  fact  of  these  interferences,  it  is  well 
to  remember  that  practically  they  may  be  avoided  by  the 
employment  of  chloroform  instead  of  ether  as  the  proper 
solvent  to  extract  the  strychnin  from  organic  mixtures  ; 
morphin  and  other  interfering  substances  being  insoluble  in 
this  menstruum. 

Fallacies.  — Exception  has  been  taken  to  the  color-test  on 
the  ground  that  other  substances  besides  strychnin  will 
yield  colors  similar  if  not  identical  when  similarly  treated, 
but  a  careful  attention  will  readily  avoid  all  difficulty.  The 
substances  alluded  to  are  curarin,  veratrin,  cod-liver  oil, 
salicin,  santonin,  anilin,  narcein,  papaverin,  and  solanin ; 
but  in  relation  to  most  of  these  a  radical  ground  of  dis- 
tinction is  that  they  are  colored  by  sulphuric  acid  alone, 
which  is  not  the  case  with  strychnin.  A  salt  of  anilin  is 
not  colored  by  the  acid  alone,  but  only  in  the  presence  of 
one  of  the  above-mentioned  oxidizing  bodies  ;  but  the 
former  is  first  colored  green,  then  a  persistent  blue,  and 
finally  black. 

Curarin  has  many  points  of  resemblance  to  strychnin ;  it 
is  very  bitter ;  it  yields  a  succession  of  colors  with  sulphuric 
acid  and  potassium  dichromate,  but  it  is  much  more  soluble 
in  water,  forms  amorphous  compounds  with  potassium  di- 
chromate, and  is  colored  purple  by  strong  nitric  acid  ;  it  is 
nearly  insoluble  in  chloroform  and  readily  soluble  in  alka- 
lies. Its  physiological  effects  are  the  opposite  of  those  of 
strychnin. 

Cod-liver  oil,  when  treated  with  sulphuric  acid  alone, 
affords  a  play  of  colors  somewhat  like  those  presented  by 
strychnin. 

2.  Galvanic  Test.  —  This  acts  on  the  same  principle  of 
presenting  nascent   oxygen   to  the  strychnin,   but  in   this 


STRYCHNIN PICRIC    ACID.  593 

instance  it  is  evolved  by  electricity.  A  drop  of  a  dilute 
solution  of  strychnin  is  placed  in  a  small  depression  made 
on  platinum  foil,  or  in  a  platinum  capsule,  allowed  to  evap- 
orate to  dryness,  and  then  moistened  with  a  drop  of  sul- 
phuric acid.  The  foil  (or  capsule)  is  connected  with  the 
positive  pole  of  a  single  cell  of  Grove's  battery,  and  the  acid 
is  touched  with  the  platinum  terminal  from  the  negative 
pole.  Instantly  the  violet  color  will  flash  out  on  the  metal, 
and  on  removing  the  pole  from  the  acid  the  tint  will 
remain. 

3.  Sodium  hydroxid  or  aininonium  hydi'oxid  precipitates 
the  alkaloid  from  a  somewhat  concentrated  solution  in  the 
crystalline  form.  The  best  method  is  to  expose  a  drop  of 
the  solution  on  a  glass  slide  to  the  vapors  of  ammonium 
hydroxid  and  place  it  under  the  microscope  ;  the  beautiful 
formation  of  the  long  stellate  prismatic  crystals  can  easily 
be  distinguished ;  these  can  be  identified  by  touching  them 
with  a  drop  of  sulphuric  acid  and  a  small  amount  of  man- 
ganese dioxid,  when  the  play  of  colors  will  take  place. 

4.  Potassium  Bichromate.  — A  solution  of  this  salt  throws 
down  from  a  strychnin  solution  a  bright-yellow  precipitate, 
which  soon  becomes  crystalline.  Placed  under  the  micro- 
scope these  crystals  appear  in  groups  mingled  with  octa- 
hedral plates.  When  dried,  these  should  be  verified  by 
touching  them  with  a  drop  of  sulphuric  acid,  which  pro- 
duces the  play  of  colors.     This  is  a  satisfactory  test. 

5.  Picric  Acid.  —  A  solution  of  this  acid  precipitates 
strychnin  from  its  solution  in  the  form  of  abundant  yellow 
crystals.  The  best  mode  of  showing  it  is  to  add  a  drop  of 
the  solution  to  one  of  strychnin  on  a  glass  slide,  and  view 
the  reaction  under  the  microscope.  The  precipitate  which 
first  forms  soon  assumes  the  appearance  of  tufts  of  yellow 

50 


594  TOXICOLOGY. 

crystals  of  a  peculiar  claw-like  form.  These,  as  in  the 
former  experiment,  may  be  subjected  to  the  color-test  by 
the  same  method. 

Besides  the  above  tests  there  are  others  of  inferior  value, 
as  platinum  chlorid,  potassium  iodid,  and  potassium  thio- 
cyanate. 

6.  Physiologic  Test. — The  extreme  susceptibility  of  the 
frog  to  the  action  of  strychnin  was  first  employed  by  Mar- 
shall Hall  as  a  test  for  this  poison.  It  may  be  applied 
either  by  immersing  a  small  frog  in  the  strychnin  solution 
or  by  injecting  it  into  the  throat  of  the  animal  or,  preferably, 
under  the  skin.  Dr.  Reese  reports  that  he  has  had  many 
satisfactory  results  with  this  test.  One  of  these  experiments 
demonstrates  very  clearly  the  extreme  susceptibility  of  the 
frog  to  the  influence  of  strychnin :  "  The  one  five-hundredth 
of  a  grain  of  strychnin  was  put  into  the  throat  of  a  middling- 
sized  frog ;  it  was  convulsed  and  died  in  about  thirty 
minutes.  The  extract  obtained  from  the  stomach  by  Stas' 
process,  although  it  afforded  no  perceptible  color-test,  had 
a  bitter  taste,  and  produced  "tetanic  spasms  in  several  small 
active  frogs." 

Dr.  Reese's  experiments  in  this  line  further  demonstrated 
the  fact  that  while  morphin,  when  present  in  excess  with 
strychnin  in  small  quantities,  has  the  power  to  disguise  the 
color-test,  it  affords  no  obstacle  to  the  employment  of  the 
frog-test.  Two  experiments  may  be  quoted  under  this 
head:  "A  frog  weighing  thirty -five  grains  was  immersed 
in  a  solution  of  the  strength  of  one  fourth  of  a  grain  of 
strychnin  and  eight  grains  of  morphin  to  one  pint  of  water  ; 
it  was  convulsed  in  twenty  minutes.  Another  animal, 
rather  smaller,  was  convulsed  in  five  minutes."  (In  these 
experiments  only  a  small  portion  of  the  solution  was  used, 


STRYCHNIN TOXICOLOGIC    EXAMINATION.  595 

less  than  a  fluid-drachm,  put  into  a  conical  glass,  in  which 
the  hind-quarters  only  of  the  animal  were  immersed.)  "  A 
cat  was  poisoned  with  one  twentieth  of  a  grain  of  strychnin 
and  one  tenth  of  a  grain  of  morphin.  The  stomach,  on  ex- 
amination by  Stas'  process,  failed  to  yield  the  color-test ; 
but  the  watery  solution  of  the  extract  produced  most  de- 
cided tetanic  convulsions  in  eight  frogs,  generally  resulting 
in  death." 

The  physiologic  test,  although  so  important  for  cor- 
roboration, should  not  be  reUed  on  exclusively  in  the  ab- 
sence of  the  chemical  tests,  since  several  other  substances, 
including  some  of  the  ptomains,  produce  somewhat  similar 
symptoms. 

Toxicologic  Examination.  — The  stomach  properly  divided, 
together  with  its  contents,  and  a  sufficient  quantity  of  dis- 
tilled water,  should  be  made  distinctly  acid  with  pure  acetic 
acid.  If  the  elaborate  process  of  Stas  is  to  be  employed, 
the  strongest  alcohol  must  be  used  instead  of  water.  In 
either  case  the  mass  should  be  digested  on  a  water- bath  for 
several  hours.  A  high  temperature  is  objectionable,  as  it 
dissolves  out  the  starchy  matters.  After  cooling,  it  is 
strained  through  muslin,  and  the  solid  matters  washed  with 
dilute  alcohol,  and  pressed.  The  liquid  should  next  be 
concentrated  by  evaporation,  and  filtered  through  paper. 
It  should  now  be  evaporated  to  dryness.  The  residue  will 
contain  any  strychnin  that  may  be  present,  in  the  form  of 
acetate,  mixed  with  organic  matter.  This  residue  should 
now  be  thoroughly  mixed  with  a  small  quantity  of  distilled 
water  containing  a  few  drops  of  acetic  acid,  then  filtered 
through  paper,  and  the  filtrate  shaken  up  successively  with 
ether,  benzene,  chloroform,  and  amylic  alcohol,  which  will 
remove  many  impurities,  but  will  not  dissolve  the  strychnin 


596  TOXICOLOGY. 

in  the  acid  solution.  It  is  then  poured  into  a  glass  tube  or 
flask,  and  an  excess  of  sodium  carbonate  or  ammonium 
hydroxid  added,  which  liberates  the  strychnin.  Pure  chlo- 
roform, slightly  in  excess  of  the  mixture,  is  now  added,  and 
the  whole  briskly  shaken  together  for  some  minutes.  Blyth 
recommends  to  add  the  chloroform  before  the  alkali ;  the 
strychnin  is  more  soluble  before  it  assumes  the  crystalline 
condition.  The  chloroform  dissolves  out  the  alkaloid,  and 
collects  at  the  bottom  of  the  mixture  after  the  lapse  of 
some  time. 

To  separate  the  chloroform  from  the  supernatant  liquid 
the  easiest  practical  method  is  to  transfer  the  whole  mix- 
ture to  a  stoppered  glass  funnel,  or,  what  answers  equally 
well,  a  glass  syringe  of  proper  size  after  removing  the 
piston,  and  having  previously  contracted  the  nozzle  to  a 
fine  point  by  means  of  the  flame.  Before  introducing  the 
liquid,  this  small  aperture  should  be  plugged  with  a  splinter 
of  wood,  and  about  half  a  drachm  of  pure  chloroform  first 
poured  into  the  syringe,  so  as  to  about  fill  the  narrow  por- 
tion. The  mixture  is  now  to  be  carefully  poured  in  and  a 
sufficient  time  allowed  to  elapse  for  the  chloroform  to  sepa- 
rate and  settle  to  the  bottom.  By  placing  the  thumb  over 
the  larger  aperture  of  the  syringe,  and  withdrawing  the 
wooden  plug,  it  will  be  very  easy  to  control  the  flow  of  the 
contents.  A  few  drops  may  be  allowed  to  fall  successively, 
as  each  one  dries,  into  a  warmed  watch-glass  or  porcelain 
capsule,  for  a  trial  by  the  color-test.  The  whole  of  the 
chloroform  is  then  permitted  to  flow  out  into  one  or  more 
capsules  or  watch-glasses,  great  care  being  taken  not  to 
alllow  any  of  the  other  mixture  to  escape  along  with  it.  The 
remaining  alkaline  liquid  may  be  shaken  up  with  an  addi- 
tional portion  of  chloroform,  and  the  separation  again  made 


STRYCHNIN TOXICOLOGIC    EXAMINATION.  59/ 

as  before.  All  the  chloroform  is  now  permitted  to  evapo- 
rate spontaneously  to  dryness.  The  contained  strychnin,  if 
of  notable  quality,  will  usually  be  found  in  the  deposit  in  an 
amorphous  form. 

As  a  trial-test,  a  portion  of  this  extract  should  now  be 
examined  by  the  taste  for  bitterness  ;  by  the  color-test 
(although  this  may  not  be  very  satisfactoiy,  on  account  of 
the  mixture  with  organic  matter),  and  by  the  frog-test. 
The  remaining  portion  of  the  extract  is  to  be  dissolved  in  a 
minute  quantity  of  water,  acidulated  with  acetic  acid,  filtered 
and  subjected  to  the  usual  tests. 

The  main  difficulty  in  considering  this  experiment  arises 
from  the  presence  of  organic  matters  in  connection  with  the 
strychnin.  If  the  chloroform  extract  has  a  yellow  color 
(denoting  its  impurity),  a  few  drops  of  strong  sulphuric  acid 
should  be  added  to  it  and  thoroughly  stirred  with  a  glass 
rod  and  gently  heated.  This  blackens,  destroys,  and  car- 
bonizes the  organic  matter  and  converts  the  strychnin  into 
a  sulphate  ;  add  a  few  drops  of  water.  After  standing  a 
short  time  the  dark  liquid  is  filtered,  sodium  carbonate  or 
ammonium  hydroxid  added  in  excess,  then  pure  chloro- 
form, as  explained  above.  The  second  extract  thus  pro- 
cured is  generally  sufficiently  pure  for  all  practical  pur- 
poses. 

It  not  infrequently  happens,  when  operating  on  complex 
organic  mixtures  by  the  chloroform  process,  that  difficulty 
is  experienced  in  getting  the  chloroform  to  separate  from 
the  alkaline  solution,  the  whole  mass  forming  a  sort  of 
emulsion.  In  such  a  case  the  tube  may  be  immersed  in 
hot  water  for  some  time,  and  if  this  does  not  answer,  nothing 
remains  but  to  agitate  the  mixture  several  times  successively 
with  about  half  its  volume  of  pure  water,  allowing  it  to  rest 


598  TOXICOLOGY. 

each  time,  and  separating  the  chloroform  as  before  directed. 
The  separation  can  often  be  promoted  by  the  use  of  a  cen- 
trifugal machine.  The  mixture  is  slightly  acidulated  by 
acetic  acid,  then  transferred  to  a  small  dish,  and  evaporated 
to  dryness  on  a  water-bath  ;  the  residue  is  stirred  with  a 
very  small  quantity  of  pure  water  ;  the  solution  is  filtered, 
rendered  slightly  alkaline,  and  again  agitated  with  fresh 
chloroform,  which  usually  will  readily  separate. 

The  method  of  dialysis  has  been  recommended  by  some 
authorities,  but  does  not  seem  to  be  as  satisfactory  as  the 
one  just  described. 

Detection  in  the  Tissues  and  Blood.  — Strychnin  is  absorbed 
into  the  circulation  and  deposited  in  the  various  organs, 
just  like  the  mineral  poisons.  The  rapidity  with  which  the 
absorption  takes  place  is  shown  in  a  case  mentioned  by 
Taylor,  where  a  man  took  five  grains  of  the  poison  by 
mistake,  and  died  in  half  an  hour.  Strychnin  was  discov- 
ered in  the  stomach  in  the  quantity  of  one  grain  ;  it  was 
also  detected  in  the  liver  and  tongue.  This  case  shows 
that  within  half  an  hour  four  fifths  of  the  poison  had  been 
removed  from  the  stomach  (or  could  not  be  detected  there 
by  chemical  research),  and  had  been  diffused  throughout 
the  body.  There  are,  however,  other  cases  where  the 
circumstances  were  apparently  just  as  favorable  for  the 
absorption  and  diffusion  of  the  poison,  but  where  there  was 
a  total  failure  to  detect  it  in  the  organs  after  death. 

The  process  is  the  following :  The  organs  are  to  be  finely 
crushed  and  digested  in  strong  alcohol,  acidulated  with 
sulphuric  acid  in  the  proportion  of  eight  drops  to  the  fluid- 
ounce  of  the  mixture;  this  should  be  heated  below  212°  F. 
for  about  an  hour ;  when  cool,  it  is  to  be  filtered  and  con- 
centrated, as  before  directed.     The  residue  is  then  nearly 


STRYCHNIN FAILURE    TO    DETECT.  599 

neutralized  by  sodium  hydroxid,  care  being  taken  to  main- 
tainlin  acid  reaction,  then  filtered  and  evaporated  nearly  to 
dryness.  To  the  cool  residue  a  drachm  or  two  of  strong 
alcohol  is  added  and  thoroughly  stirred  with  it ;  this  dis- 
solves out  the  strychnin  sulphate,  and  leaves  the  potassium 
sulphate  and  the  organic  matters.  The  alcoholic  solution 
is  now  filtered,  evaporated  almost  to  dryness,  the  residue 
stirred  with  pure  water,  rendered  alkaline  by  sodium 
hydroxid,  and  finally  agitated  with  chloroform,  which  de- 
posits the  alkaloid,  if  present,  on  evaporation. 

Dr.  Taylor  recommends  acetic  acid  and  ammonium 
hydroxid  in  these  cases. 

The  method  of  Rodgers  and  Girdwood  is  somewhat 
similar ;  they  employ  hydrochloric  acid  and  ammonium 
hydroxid  as  the  reagents  along  with  chloroform. 

Strychnin  may  be  recovered  from  the  blood  by  a  similar 
process.  In  some  experiments  of  Wormley  the  poison  was 
detected  in  the  blood  of  dogs  and  cats,  where  death  took 
place  in  three  and  six  minutes  respectively  after  its  admin- 
istration. This  shows  the  extreme  rapidity  with  which  it  is 
absorbed. 

Detection  in  the  Urine. — The  urine  should  be  evaporated 
to  a  syrupy  consistence,  acidulated  with  acetic  acid  mixed 
with  an  ounce  of  strong  alcohol,  filtered  and  evaporated  to 
near  dryness.  The  residue  is  to  be  stirred  with  pure  water, 
filtered  if  necessaiy,  sodium  hydroxid  added  in  excess  and 
agitated  with  chloroform. 

Failure  to  Detect.  —  It  must  be  admitted  that  the  most 
careful  analysis  sometimes  fails  to  discover  this  poison  in 
the  body  after  death,  and  that,  too,  where  the  circumstances 
were  apparently  favorable  to  it.  This  failure  may  some- 
times be  ascribed  to  the  smallness  of  the  dose,  and  again 


600  TOXICOLOGY. 

possibly  to  some  interference — probably  some  ptomain, 
especially  when  there  is  putrefaction  ;  though  mere  putres- 
cence of  the  body  is  of  itself  no  obstacle  to  its  detection, 
since  it  has  been  recovered  months  after  death,  and  where 
the  body  was  in  an  advanced  state  of  decomposition.  Allen 
has  reported  a  case  in  which  strychnin  was  found  in  organic 
matter  after  seven  years.  Dr.  Leffmann  found  it  in  vomited 
matter  which  had  been  kept  for  nine  years.  Christison, 
Taylor,  and  other  well-known  authorities,  have  at  times 
been  foiled  in  their  efforts  to  detect  the  poison.  In  a  case 
that  Dr.  Reese  examined  some  years  ago,  in  which  a  woman 
was  poisoned  it  was  alleged  with  six  grains  of  strychnin, 
and  in  which  death  was  postponed  for  the  unusually  long 
period  of  six  hours,  there  was  a  similar  failure  to  detect  the 
poison  eight  weeks  after  death,  although  the  body  was  well 
preserved.  In  this  case  (as  already  mentioned)  morphin 
had  also  been  administered,  which  may  have  interfered  with 
the  usual  color-test. 

Brucin.  — This  alkaloid  is  generally  found  associated  with 
strychnin.  It  occurs  either  in  the  form  of  a  white  powder 
or  in  colorless  prismatic  crystals.  It  is  more  soluble  in 
water  and  alcohol  than  strychnin.  It  is  freely  soluble  in 
chloroform  and  alcohol.  It  has  an  intensely  bitter  taste. 
Concentrated  sulphuric  acid  dissolves  it,  giving  a  faint  rose 
coloration.  It  does  not  respond  to  the  color-test  of  stiych- 
nin.      Nitric  acid  gives  a  characteristic  blood-red  color. 

Its  poisonous  properties  are  similar  to  those  of  strychnin, 
though  much  less  intense.  As  the  symptoms  of  poisoning 
by  it  are  similar  to  those  caused  by  strychnin,  the  toxicolo- 
gist  should  guard  against  being  deceived  in  a  medico-legal 
investigation,  in  the  event  of  not  discovering  strychnin  by 


CEREBRO-SPINAL    NEUROTICS.  6oi 

the   usual  color-test.      In  such  a  case  it  would  always  be 
proper  to  search  for  brucin. 

Tests.  —  (i)  The  characteristic  reagent  is  nitric  acid,  which 
instantly  produces  a  blood-red  color  with  a  speedy  solution 
of  the  alkaloid.  If  heated  the  color  changes  to  yellow.  If 
after  cooling  a  drop  of  the  solution  of  stannous  chlorid  be 
added,  the  color  changes  to  a  beautiful  purple.  The  some- 
what similar  red  color  produced  on  morphin  by  nitric  acid 
is  not  changed  by  protochlorid  of  tin. 

(2)  Sulphuric  Acid  and  Potassium  Nitrate. — Touch  the 
fragment  of  brucin  with  a  drop  of  strong  sulphuric  acid,  and 
a  faint-rose  color  is  produced  ;  then  add  a  small  crystal  of 
potassium  nitrate,  when  the  color  changes  to  a  deep  orange- 
red. 

(3)  Ammonium  hydroxid  produces  with  a  drop  of  brucin 
solution  a  beautiful  crystallization,  viewed  by  the  micro- 
scope. 

Blyth  regards  methyl  iodid  as  the  best  test  for  brucin. 
If  it  is  added  to  a  strong  alcoholic  solution  of  brucin,  circu- 
lar rosettes  of  crystals  appear.  This  test  does  not  act  with 
strychnin. 

The  frog-test  is  equally  applicable  to  brucin,  allowing  for 
its  comparative  inferiority  in  strength  to  strychnin. 

The  toxicologic  examination  for  brucin   is   conducted   in 

the  same  manner  as  described  for  strychnin.     The  ultimate 

extract  is  to  be  tested  by  nitric  acid  and  stannous  chlorid. 

Brucin  has  been  detected  in  the  blood  of  animals  poisoned 

by  it. 

CEREBRO-SPINAL   NEUROTICS. 

A  subdivision  of  Cerebro-spinal  Neurotics  has  received 
the  name  of  Deliriants  because  of  the  active  delirium  that 
constitutes  one  of  their  prominent  symptoms.     They  also 


602  TOXICOLOGY. 

produce  other  effects  in  common,  such  as  illusion  of  the 
senses,  dilatation  of  the  pupil,  heat  and  dryness  of  the 
throat,  a  flushed  face,  and  frequently  a  redness  of  the  skin. 
They  all  belong  to  the  same  natural  order  of  plants,  Sola- 
nacecB.  From  their  physiological  property  of  dilating  the 
pupil  they  have  received  the  name  of  Mydriatics.  They 
comprise  Belladonna,  Stramonium,  Hyoscyamus,  and  dif- 
ferent species  of  Solanum. 

BELLADONNA. 

Belladonna  [Deadly  Nightshade).  —  The  leaves,  berries, 
and  root  of  Atropa  belladonna  are  violently  poisonous.  The 
leaves  and  root  are  used  in  medicine.  Children  are  fre- 
quently poisoned  by  eating  the  berries. 

Symptoms. — A  sense  of  heat  and  dryness  in  the  mouth 
and  throat,  difficulty  of  swallowing,  nausea,  vomiting, 
giddiness,  extreme  dilatation  of  the  pupil,  loss  of  vision, 
flushed  face,  sparkHng  eyes,  delirium  of  an  excited,  mani- 
acal character,  spectral  illusions,  convulsions,  followed  by 
stupor  and  coma.  Irritation  of  the  urinary  organs  fre- 
quently occurs,  such  as  strangury,  suppression  of  urine, 
and  hematuria.  A  scarlet  eruption  is  often  observed  over 
the  skin.  Some  of  these  effects  have  been  produced  by  the 
external  application  of  belladonna  in  the  form  of  a  plaster  or 
liniment.  The  symptoms  of  belladonna  poisoning  usually 
show  themselves  in  from  half  an  hour  to  two  hours,  occa- 
sionally sooner ;  they  do  not  generally  terminate  fatally. 
Death,  when  it  occurs,  usually  takes  place  within  twenty- 
four  hours. 

In  case  of  death  from  the  leaves  or  seeds  of  belladonna, 
these  can  usually  be  distinguished  in  the  alimentary  canal 
by  their  botanical  characters,  as  shown  by  the  microscope. 


ATROPIN.  603 

Atropin.  —  This  alkaloid  is  the  active  principle  of  bella- 
donna and  is  a  very  powerful  poison,  producing  symptoms 
similar  to  those  above  described,  only  more  speedily.  The 
application  of  a  weak  solution  to  the  eyes  has  occasioned 
symptoms  of  belladonna  poisoning.  Used  hypodermically, 
even  in  doses  of  one  fiftieth  to  one  tenth  of  a  grain,  it  occa- 
sions at  times  violent  symptoms.  Employed  in  this  manner 
in  combination  with  morphin  in  excess  its  activity  appears 
to  be  modified.  Death  has  resulted  from  the  external  use 
of  a  strong  ointment  of  atropin. 

The  following  are  some  recently  reported  cases.  Atropin 
poisoning  now  often  occurs  by  mistaking  the  solution  for 
morphin, 

I .  A  weak,  1 1  -year-old,  boy  drank  a  watery  solution  of  50 
milligrams  (five  sixths  of  a  grain)  of  atropin  sulphate.  Dur- 
ing the  first  three  hours  the  mother  noticed  that  the  boy 
made  frequent  vists  to  the  water-closet,  and  was  very  rest- 
less. He  finally  developed  delirium  of  such  intensity  that 
two  persons  could  scarcely  hold  him.  The  skin  was  pale, 
the  pulse  small  and  very  rapid,  the  pupils  widely  dilated 
and  insensitive.  When  seen  by  the  physician,  after  the  ex- 
piration of  three  hours,  it  was  considered  useless  to  employ 
lavage.  Vinegar  was  administered  and  an  enema  of  half  a 
gram  (7.5  grains)  of  chloral  hydrate.  The  delirium  abated 
very  much  and  the  patient  slept  for  two  hours,  but,  when  he 
awoke,  excitement  again  appeared,  and  continued  during  the 
night.  By  morning  the  condition  had  improved,  but  oc- 
casional delirium  still  appeared.  The  boy  saw  white  mice, 
looked  for  money  in  the  bed  and  had  other  delusions.  He 
recovered,  but  complained,  for  ten  days  after  the  taking  of 
the  poison,  of  headache,  dryness  of  throat  and  disturbed 
vision. 


604  TOXICOLOGY. 

2.  A  woman,  57  years  old,  affected  with  rectal  cancer,  had 
been  treated  during  a  long  period  with  morphin  to  relieve 
the  suffering.  By  mistake  she  received  at  2.30  P.  M.  5 
milligrams  (one  thirteenth  of  a  grain)  of  atropin.  At  4 
o'clock  she  had  a  bloated  and  ruddy  face,  complained  of 
much  discomfort  and  of  a  marked  bitter  taste.  At  6  o'clock 
she  had  developed  a  very  strong  erythema  of  the  face,  which 
was  much  swollen,  the  pupils  were  dilated  to  the  maximum 
and  there  was  dryness  of  the  throat  and  thirst.  At  6.30 
(the  mistake  not  having  been  as  yet  recognized)  another  dose 
of  the  atropin  was  given,  whereupon  she  became  delirious 
and  had  to  be  held  down  to  the  bed.  She  became  calm 
and  went  to  sleep,  about  9  o'clock,  at  which  time  the  error 
was  discovered,  and  40  milligrams  (two  thirds  of  a  grain)  of 
morphin  were  injected  subcutaneously.  Strong  coffee  was 
also  given.  The  pupils  were  dilated,  insensitive  and  the  face 
pale.  By  the  next  morning  the  condition  was  so  far  im- 
proved that  she  could  answer  questions  in  a  weak  voice,  but 
apparently  did  not  recognize  persons.  She  complained  still 
of  thirst  and  dryness  of  the  throat. 

3.  A  woman,  aged  28,  was  given,  by  mistake,  a  subcu- 
taneous injection  of  atropin  (3  milligrams,  equivalent  to  one 
twentieth  of  a  grain).  In  an  hour  her  face  became  erythema- 
tous, with  twitching  in  the  left  arm  and  dryness  of  throat. 
She  expressed  much  alarm,  but  lay  quiet  with  dilated  im- 
movable pupils.  An  injection  of  a  quantity  of  morphin  equal 
to  that  of  the  atropin  soon  produced  sleep  and  the  next 
morning  she  exhibited  no  unfavorable  symptoms. 

Fatal  Dose.  —  One  half  to  three  quarters  of  a  grain  may 
be  regarded  as  a  minimum  fatal  dose  for  an  adult.  The 
criminal  administration  of  this  poison  is  very  rare.  Taylor 
records  a  case  where  a  surgeon  of  a  workhouse  was  fatally 


ATROPIN ANALYTIC    METHODS.  605 

poisoned  by  a  nurse  by  administering  it  in  milk.  The  diag- 
nosis is  not  always  easy,  since  the  same  symptoms  are  pro- 
duced by  hyoscyamus  and  stramonium.  There  appears  to 
be  a  special  tendency  to  its  elimination  from  the  system  by 
the  kidneys.  Guy  states,  on  the  authority  of  Harley,  that 
the  presence  of  atropin  in  the  urine  can  be  readily  proved 
within  twenty  minutes  after  the  injection  under  the  skin  of 
one  forty-eighth  to  one  ninety-sixth  of  a  grain  by  the  action 
of  the  urine  on  the  eye.  Twelve  drops  will  largely  dilate 
the  pupil  and  maintain  it  in  that  state  for  several  hours. 

Treatment. — The  immediate  evacuation  of  the  stomach 
by  an  active  emetic  or  by  the  stomach-pump.  There  is  no 
chemical  antidote.  Morphin,  which  should  be  carefully  and 
repeatedly  administered,  seems  to  be  useful.  See  also  the 
treatments  followed  in  the  recent  cases  cited  on  the  preced- 
ing page.  The  subcutaneous  injection  of  pilocarpin  has 
been  found  very  effectual  by  Ringer  and  others. 

Post-mortem  Appearances.  —  These  are  not  characteristic. 
There  may  be  congestion  of  the  vessels  of  the  brain,  with 
some  red  patches  of  the  stomach  and  esophagus.  When 
the  poisoning  has  resulted  from  eating  the  ripe  berries,  the 
whole  lining  membrane  of  the  alimentaiy  canal  may  be 
dyed  of  a  purple  color,  and  portions  of  the  berries  and 
seeds  may  be  discovered  in  the  intestines  or  in  the  stools. 
The  blood  is  usually  fluid  and  dark-colored. 

Analytic  Methods. — Atropin,  when  pure,  occurs  in  white 
crystalline  tufts.  Its  taste  is  acrid  and  bitter  ;  slightly  solu- 
ble in  cold  water,  very  soluble  in  alcohol,  ether  and  chloro- 
form. It  sublimes  at  200°  F.  Its  color  is  not  changed  by 
either  of  the  mineral  acids.  It  has  alkaline  properties,  neu- 
tralizing acids  and  forming  salts.  If  a  minute  quantity  be 
evaporated  to  dryness  with  a  few  drops  of  a  solution  of 


6o6  TOXICOLOGY. 

barium  hydroxid,  and  heated  strongly,  an  odor  is  evolved 
resembling  that  of  hawthorn  (Blyth). 

Sodium  hydroxid  throws  down  from  solutions  of  atropin 
salts  a  precipitate  which  ultimately  becomes  crystalline. 
That  produced  by  ammonium  hydroxid  remains  amor- 
phous. It  is  also  precipitated  by  gold  chlorid  and  by  picric 
acid.  lodin  in  potassium  lodid  gives  a  reddish-brown  pre- 
cipitate with  a  very  minute  portion,  but  this  is  not  charac- 
teristic. Wormley  considers  bromin  in  hydrobromic  acid 
to  be  the  characteristic  test  for  atropin.  The  precipitate  is 
at  first  amorphous,  of  a  yellow  color ;  but  it  soon  becomes 
crystalline.  It  is  insoluble  in  acetic  acid,  and  but  slightly 
so  in  either  of  the  mineral  acids.  The  one  ten-thousandth 
to  one  twenty-five -thousandth  of  a  grain  will  give  satisfac- 
tory results  with  this  reagent. 

Another  delicate  test  is  that  of  Vitali.  A  small  portion 
is  covered  with  a  little  fuming  nitric  acid,  and  dried  on  a 
water-bath,  and  when  cold  is  moistened  with  a  drop  of 
a  solution  of  potassium  hydroxid  in  absolute  alcohol ;  a 
violet  color  is  instantly  produced,  which  soon  passes  into  a 
fine  red. 

Free  atropin,  as  obtained  by  evaporating  its  chloroform 
or  ether  solution  (after  liberation  of  the  alkaloid  from  one  of 
its  salts  by  ammonium  hydroxid),  gives  a  red  color  with 
phenolphthalein.  This  reaction  is  common  to  hyoscyamin 
and  hyoscin,  and  is  also  produced  by  the  artificial  base 
homatropin,  but  is  not  given  by  any  other  alkaloid  in  com- 
mon use  (except,  according  to  Pliigge,  the  volatile  bases 
conin  and  nicotin).  Fliickiger,  who  first  observed  the 
peculiar  behavior  of  the  tropeines  with  phenolphthalein, 
recommends  that  a  minute  quantity  of  the  alkaloid  to  be 
tested  should   be  placed   on   phenolphthalein    paper  (this 


ATROPIN TOXICOLOGIC    EXAMINATION.  607 

should  be  freshly  prepared),  which  is  then  wetted  with 
strong  alcohol.  No  coloration  will  be  produced  at  first, 
but  on  allowing  the  alcohol  to  evaporate,  and  touching  the 
alkaloid  with  a  drop  of  water,  a  brilliant  red  coloration  will 
appear.  On  adding  alcohol  the  color  is  destroyed,  but 
appears  again  as  the  spirit  evaporates. 

Toxicologic  Examination.  —  We  should  first  of  all  en- 
deavor to  discover  any  seeds  or  remains  of  the  leaves  or 
berries  of  the  plant.  The  vomit  and  stools  should,  if  possi- 
ble, be  also  examined  for  these.  The  stomach  with  its  con- 
tents, and  other  organs  properly  comminuted,  should  be 
treated  after  a  modification  of  Stas'  process,  alcohol  being 
used  as  the  solvent,  along  with  sulphuric  acid.  After 
heating,  straining,  evaporating,  purifying  by  pure  ether 
or  amyl  alcohol,  removing  the  ether,  and  adding  solution 
of  potassium  hydroxid  in  excess,  the  ultimate  extract  is 
obtained  by  chloroform,  and  tested  first  with  the  bromin 
test,  which,  if  successful,  may  be  followed  by  the  other 
tests. 

The  physiological  test  consists  in  applying  a  portion  of 
the  ultimate  extract  to  the  eyes  either  of  a  man  or  one  x)f 
the  lower  animals,  as  the  rabbit.  The  minutest  quantity 
will  produce  the  characteristic  dilatation  of  the  pupil.  It 
must,  however,  be  remembered  that  other  members  of  this 
class  of  alkaloids  will  produce  a  similar  result,  and  that 
mydriatic  ptomains  may  be  extracted  from  decomposed 
tissues. 

The  rabbit  evinces  a  remarkable  tolerance  for  belladonna 
and  its  alkaloid.  It  will  live  exclusively  on  the  former  for 
many  days,  and  tolerate  enormous  doses  of  the  latter, 
either  by  the  stomach  or  subcutaneously,  without  percep- 
tible effects. 


6o8  TOXICOLOGY. 

STRAMONIUM,    HYOSCYAMUS,    AND    SOLANUM. 

Stramonium  {Thorn  Apple,  Jamestown  Weed). — The  Da- 
tiira  stramo7iiuin  is  a  common  plant,  abounding  in  this  coun- 
try and  also  in  Europe.  It  grows  freely  on  waste  grounds  ; 
other  varieties  occur  in  India.  All  parts  of  the  plant  are 
poisonous,  especially  the  seeds  and  fruit.  Its  active  alka- 
loid principle  has  been  called  daturin,  but  is  now  regarded 
as  identical  with  atropin. 

Cases  of  poisoning  by  stramonium  are  usually  accidental, 
and  chiefly  occur  in  children  from  eating  the  seeds. 

Symptoms. — Very  similar  to  those  produced  by  bella- 
donna, such  as  dryness  of  throat,  with  difficulty  of  swallow- 
ing, dilated,  insensible  pupil,  violent  and  incoherent  delirium, 
nausea,  vomiting,  headache,  vertigo,  ringing  in  the  ears, 
spectral  illusions,  followed  by  stupor  and  coma.  Some- 
times there  are  convulsions  and  paralysis,  together  with  a 
scarlet  efflorescence  on  the  skin.  The  external  application 
of  the  bruised  leaves  has  occasioned  symptoms  of  poisoning. 

The  following  case  was  reported  in  a  Spanish  journal : 
A  man,  forty-four  years  old,  who  had  been  directed  to 
use  the  dried  leaves  of  Datura  stramonium  for  attacks  of 
asthma,  misunderstood  the  advice  and  drank  an  infusion  of 
about  six  grams  (ninety  grains)  in  water.  He  was  affected 
with  a  tickling  sensation  in  the  throat,  soon  became  uncon- 
scious and  remained  so  for  an  hour.  On  returning  to  con- 
sciousness, the  breathing  was  shallow,  sibilant  and  rapid  (50 
per  minute),  the  pulse  96,  full  and  tense,  the  face  slightly 
cyanosed,  the  pupils  dilated  and  insensitive  to  light.  There 
was  free  flow  of  saliva.  The  treatment  was  washing  out  the 
stomach  with  water  and  the  administration  of  mild  stimu- 
lants.    He  improved  promptly  and  was  well  the  next  day. 


HYOSCYAMUS ANALYSIS.  609 

In  India,  a  species  of  Datura  is  employed  by  the  thugs 
for  the  purpose  of  drugging  their  victims. 

Post-mortem  Appearances. — Very  similar  to  those  result- 
ing from  belladonna.  There  is  nothing  characteristic.  The 
seeds  and  remains  of  the  leaves  may  be  discovered  in  the 
alimentary  canal,  if  these  have  been  the  cause  of  death. 

Treatment.  —  The  same  as  that  recommended  for  bella- 
donna poisoning. 

Analysis.  —  The  seeds  are  of  a  black  or  brown  color,  kid- 
ney-shaped, with  a  wrinkled  surface.  They  are  much  larger 
than  those  of  belladonna  or  hyoscyamus.  According  to 
Guy,  it  requires  one  hundred  and  twenty  henbane  seeds 
and  ninety  of  belladonna  to  weigh  one  grain,  but  only  eight 
of  stramonium. 

The  method  of  procuring  the  alkaloid  from  the  stomach 
and  organs  is  the  same  as  that  above  described  for  atropin. 

Hyoscyamus  {Henbane^. — The  Hyoscyamns  niger  grows 
both  in  America  and  Europe.  All  parts  are  poisonous. 
The  root  is  tapering,  resembling  that  of  the  parsnip,  for 
which  it  has  often  been  mistaken.  The  medicinal  prepara- 
tions from  the  plant  are  extremely  variable  and  uncertain, 
depending  very  much  on  the  mode  of  growth,  collection, 
and  preparation. 

The  symptoms,  in  general,  resemble  those  of  belladonna 
and  stramonium. 

Analysis.  —  It  can  only  be  identified  in  the  matters  vom- 
ited, or  in  the  stomach  and  intestines  after  death,  by  the 
botanical  character  of  the  seeds,  or  fragments  of  the  leaves 
discovered. 

Hyoscyamin,  the  alkaloidal  principle,  forms  in  white, 
silky  crystals,  inodorous  when  pure,  but  is   usually  found 

51  ■ 


6 10  TOXICOLOGY. 

possessing  a  disagreeable  smell  ;  taste  acrid.  It  is  difficult 
to  isolate.  There  is  no  special  chemical  test  for  it.  It 
dilates  the  pupil,  like  atropin.  It  speedily  passes  into  the 
urine  when  swallowed. 

Solanum. — Three  species  of  the  genus  Solanwn  are 
usually  referred  to  in  the  books  as  possessing  poisonous 
properties ;  these  are  vS.  dulcamara,  Bittersweet  or  Woody 
Nightshade ;  S.  nigrum,  Garden  Nightshade ;  and  S.  tube- 
rosum, Common  Potato.  They  all  contain  a  substance 
called  solanin. 

The  6".  dulcamara  is  cultivated  in  gardens  as  an  orna- 
ment. Its  berries  are  sometimes  eaten  by  children,  occa- 
sioning poisonous  results.  The  dried  stems  are  used  me- 
dicinally. 

The  vS",  nigrum  produces  white  flowers  and  black  berries. 
The  latter,  like  the  fruit  of  the  ^.  didcamara,  have  fre- 
quently proved  poisonous  to  children  who  have  swallowed 
them.  They  are  more  powerful  in  their  effects  than  the 
others. 

The  following  case  shows  the  effects  of  a  poisonous  dose 
of  this  drug.  A  boy  nearly  four  years  old,  ate  some  ber- 
ries of  the  plant  growing  near  his  home,  as  was  learned 
subsequent  to  the  full  development  of  the  symptoms.  There 
was  at  first  active  movement  of  the  bowels,  which  finally 
became  involuntary.  The  next  morning  he  had  fever  and 
cramps.  When  seen  by  the  physician  at  1 1  A.  M.,  he  was 
lying  in  stupefied  condition,  but  answered  questions.  The 
skin  was  reddened  and  covered  with  sweat,  the  pulse  strong 
and  quick,  the  temperature  102.9°  F.  The  pupils  were 
symmetrically  dilated  but  not  to  the  maximum,  the  reflexes 
were  increased.      Occasional  cramp-like  shivers  occurred. 


SOLANUM.  6ll 

The  involuntary  discharges  from  the  bowels  contained 
numerous  fragments  of  the  berries.  As  eighteen  hours  had 
passed  since  the  poisonous  material  had  been  taken,  no  at- 
tempt was  made  to  wash  out  the  stomach  or  to  use  emetics. 
Enemata  were  employed  to  subdue  the  enteritis,  and  Dover's 
powder  was  given.  This  caused  vomiting.  The  boy  was 
seen  again  at  4  P.  M.,  but  had  become  much  worse  and  at 
8  P.  M.  died. 

vS.  tuberosum  is  the  common  potato.  The  berries  and 
young  shoots  have  proved  poisonous,  the  former  fatally  in 
the  case  of  a  young  girl.  Christison  quotes  an  instance  in 
which  four  persons  of  a  family  were  seized  with  alarming 
symptoms,  such  as  vomiting,  coma,  and  convulsions,  after 
eating  potatoes  that  had  commenced  to  sprout  and  shrivel. 

The  general  symptoms  produced  by  solanin  are  very 
similar  to  those  resulting  from  the  mydriatics.  It  is  much 
less  powerful  than  the  other  bodies  of  this  class. 

When  pure,  solanin  is  in  the  form  of  delicate  acicular 
crystals,  nearly  insoluble  in  water,  soluble  in  alcohol,  less 
so  in  ether,  insoluble  in  chloroform.  It  is  also  soluble  in 
amylic  alcohol.  The  hot  solution  in  the  latter  has  the  prop- 
erty of  gelatinizing  on  cooling,  even  in  so  small  a  quantity 
as  one  part  in  a  thpusand.  Cold  sulphuric  acid  first  changes 
it  into  an  orange-yellow,  and  then  dissolves  it,  the  solution 
becoming  brown.  Nitric  acid  dissolves  it,  the  solution 
being  at  first  colorless,  and  subsequently  changing  to  a  rose- 
red  tint.  The  former  acid  is  the  best  test  for  it.  Other 
reagents  do  not  give  characteristic  results. 

Solanin  is  separated  from  organic  mixtures  by  a  modifi- 
cation of  Stas'  process  ;  alcohol  and  sulphuric  acid  being 
employed  as  the  solvent,  and  warm  alcohol  to  separate  the 
final  extract. 


6l2  TOXICOLOGY. 

Cocain. — This  is  a  crystalline  alkaloid,  found  in  the 
leaves  of  the  ErytJiroxylon  coca.  It  is  colorless ;  has  a  bit- 
ter taste  ;  is  nearly  insoluble  in  water  and  alcohol ;  soluble 
in  ether.  In  small  doses  it  is  a  cerebral,  cardiac,  respiratory, 
and  nervous  stimulant.  Overdoses  produce  great  embar- 
rassment of  the  heart  and  lungs,  the  pulse  becoming  small, 
rapid,  and  intermittent ;  respiration  slow  and  feeble.  Death 
occurs  from  spasm  of  the  heart  and  muscles  of  respiration. 
It  also  occasions  delirium  and  hallucinations,  and  likewise 
dilates  the  pupils,  whether  taken  internally  or  externally. 
It  is  sometimes  taken  to  correct  the  morphin  habit,  but  is 
very  apt  to  substitute  its  own  habit  upon  the  unfortunate 
patient. 

Cocain  is  valuable  as  a  local  anesthetic  in  from  4  to  lo 
per  cent,  solutions,  as  an  application  to  painful  affections 
of  the  nose,  ear,  and  throat ;  also  in  minor  surgical  opera- 
tions. This  local  application  sometimes  produces  danger- 
ous symptoms ;  in  one  case  so  small  an  amount  as  two 
thirds  of  a  grain  produced  death.  Caffein,  nitroglycerin, 
amyl  nitrite,  and  strychnin  have  been  used  as  antidotes  with 
advantage. 

The  cocain  habit  is  marked  by  insomnia,  loss  of  digestive 
power,  enfeeblement  of  mind,  emaciation,  hallucinations, 
delirium,  and  general  loss  of  health  —  a  condition  much  re- 
sembling the  worst  effects  of  opium. 

Cocain  is  usually  employed  in  the  form  of  hydrochlorid. 
Alkaloids  of  this  type  are  contained  in  many  of  the  prep- 
arations now  used  for  producing  local  anesthesia  in  the  ex- 
traction of  teeth.  A  small  amount  of  phenol  is  also  often 
present  in  these  liquids. 

The  most  striking  tests  for  cocain  or  its  salts  in  aqueous 
solution  are  the   crystalline  precipitates  produced   by  gold 


TOBACCO SYMPTOMS.  6 1  3 

chlorid,  platinum  chlorid,  and  picric  acid.  lodin  in  potas- 
sium iodid  produces  a  rose -colored  precipitate  in  very  dilute 
solution,  and  a  brown  one  in  stronger  solutions,  which  is 
not  crystalline.  When  cocain  is  subjected  to  Vitali's  test 
(see  under  atropin),  a  distinct  odor  of  peppermint  or  citron- 
ella  is  noticed. 

'  Recently  several  artificial  substances,  analogous  to  cocain 
in  composition  and  properties,  have  been  introduced  into 
medical  practice,  especially  as  local  anesthetics.  Among 
these  is  eucain.  It  is  sold  principally  in  the  form  of  hydro- 
chlorid.      Little  is  known  as  yet  as  to  its  toxicology. 

Several  of  the  cerebro-spinal  neurotics  are  conveniently 
classified  as  depressants,  because  they  produce  great  depres- 
sion of  the  muscular  system,  though  they  differ  materially 
in  other  respects. 

The  anesthetics  of  this  type  have  been  much  used  lately 
for  the  so-called  "lumbar  puncture,"  that  is,  the  introduc- 
tion of  a  solution  into  the  spinal  canal  for  the  purpose  of 
producing  general  anesthesia  of  the  lower  part  of  the  body 
without  unconsciousness.  Fatal  results  have  occasionally 
happened  from  this. 

TOBACCO   AND   LOBELIA. 

Tobacco  is  the  dried  leaves  of  Nicotiana  tabacuui,  a  plant 
belonging  to  the  natural  order  of  Solanacece.  It  owes  its 
activity  and  poisonous  properties  to  a  volatile  oily  alkaloid 
(nicotin),  which  somewhat  resembles  conin,  and  which  exists 
in  different  proportions  in  different  specimens  of  the  leaves, 
varying  from  two  to  eight  per  cent. 

Symptoms.  —  A  large  dose  of  tobacco  (or  even  a  small  one 
to  those  unaccustomed  to  its  use)  produces  veiy  decided 
symptoms.     Very  soon  after  taking  it,  either  by  swallowing 


6l4  TOXICOLOGY. 

or  enema,  it  occasions  nausea,  giddiness,  a  sense  of  confu- 
sion of  the  head,  vomiting,  severe  retching,  great  prostra- 
tion, heat  in  the  stomach,  frequent  and  very  feeble  pulse, 
cold,  clammy  skin,  trembling  of  the  limbs,  and  sometimes 
severe  purging.  Respiration  is  difficult,  and  urination  in- 
voluntary. In  some  cases  there  is  violent  pain  in  the  abdo- 
men ;  in  others  there  is  a  great  sense  of  depression  and  of 
impending  death.  Convulsions  of  a  tetanic  character  some- 
times occur.  The  pupils  are  not  always  similarly  affected. 
Taylor  states  that  they  are  dilated.  Percival  speaks  of  it  as 
differing  from  belladonna  in  contracting  them  ;  also  by  the 
absence  of  delirium  and  of  dryness  of  the  throat.  Wharton 
and  Stille  state  that  the  pupils  are  but  slightly  affected. 

The  external  application  of  tobacco,  either  to  the  sound 
skin  or  to  abraded  surfaces,  produces  alarming  and  even 
fatal  effects.  A  wet  leaf  put  around  the  throat  in  spasmodic 
croup  often  relieves  the  spasm,  but  it  should  be  used  with 
great  caution  on  a  young  child.  A  decoction  applied  to  the 
skin  of  a  man  for  an  eruptive  disease  caused  death  in  three 
hours. 

Its  fatal  effects,  when  administered  by  the  rectum,  are 
well  known.  It  was  formerly  much  used  in  this  manner 
to  aid  the  taxis  in  strangulated  hernia,  but  it  is  always  a 
dangerous  remedy.  Even  tobacco  smoke,  diffused  through 
water  and  swallowed,  has  caused  the  death  of  a  young  infant. 

Tobacco  smoking  has  been  known  to  produce  violent  and 
even  fatal  effects  when  carried  to  great  excess,  although 
there  is  considerable  diversity  of  opinion  as  to  whether  nic- 
otin  is  present  in  tobacco  smoke  or  not.  Authorities  are 
found  on  both  sides. 

The  rapidity  of  the  effects  of  tobacco  on  the  human  sys- 
tem varies  with  the  dose  and  mode  of  administration.     In 


NICOTIN.  615 

one  case  snuff  swallowed  in  whisky  Caused  death  in  one 
hour.  In  another  instance,  quoted  by  Beck,  an  enema  of 
tobacco,  used  to  expel  worms,  produced  violent  convul- 
sions and  death  in  fifteen  minutes.  Christison  gives  another 
case  where  a  tobacco  enema  proved  fatal  in  thirty-five  min- 
utes. The  application  of  nicotin  to  the  tongue  of  an  animal 
caused  death  within  two  minutes. 

Post-mortem  Appearances.  —  There  is  no  characteristic 
lesion.  A  diffused  redness  over  the  mucous  surface  of  the 
stomach  and  bowels,  with  an  empty  heart  and  congestion 
of  the  vessels  of  the  brain,  liver  and  lungs,  are  about  all 
that  will  be  found.  The  blood  is  usually  very  dark  and 
liquid.  If  the  leaf  or  powder  has  been  swallowed,  these 
may  be  recognized  by  microscopic  examination.  In  a  case 
of  suicide  Taylor  found  general  relaxation  of  the  muscular 
system,  staring  eyes,  bloated  and  livid  features,  the  vessels 
of  the  brain  and  scalp  and  also  of  the  lungs  gorged  Avith 
black  blood,  and  the  heart  empty  except  its  left  auricle. 
There  was  intense  congestion  of  the  mucous  membrane  of 
the  stomach  and  of  the  liver.  The  blood  was  liquid,  and 
in  some  parts  had  the  consistence  of  treacle.  No  peculiar 
odor  was  perceptible. 

Nicotin. — This  alkaloid  when  pure  is  a  colorless,  oily 
liquid  which,  on  exposure,  becomes  light  yellowish  and 
thicker  in  consistence.  It  produces  a  greasy,  volatile  stain 
on  paper,  like  conin.  It  is  usually  said  to  possess  an  acrid, 
unpleasant  odor,  but  if  perfectly  pure  the  smell  is  ethereal 
and  agreeable.  It  has  a  strong,  alkaline  reaction  and  a 
density  of  i.oiii.  It  is  freely  soluble  in  water,  alcohol, 
ether,  chloroform,  turpentine  and  the  fixed  oils.  Ether 
and  chloroform  will  extract  it  from  its  watery  solution.     Its 


6l6  TOXICOLOGY. 

taste  is  very  pungent  and  acrid,  even  when  much  diluted, 
causing  a  pecuhar  sensation  in  the  throat  and  air  passages. 
It  slowly  distills  at  about  295°  F.,  and  boils  at  about 
470°  F.  Heated  oh  platinum  it  burns  with  a  bright  flame, 
emitting  a  thick  black  smoke. 

Nicotin  is  one  of  the  most  rapidly  fatal  poisons  known, 
even  rivaHng  prussic  acid.  A  single  drop  destroyed  a 
rabbit  in  three  and  a  half  minutes.  In  Wormley's  experi- 
ments one  drop  placed  in  the  mouth  of  a  full-grown  cat 
produced  immediate  prostration,  continued  convulsions, 
and  death  in  seventy-eight  seconds. 

In  the  celebrated  case  of  Count  Bocarme,  who  was  exe- 
cuted in  Belgium,  185  i,  for  poisoning  his  brother-in-law, 
Gustave  Fougnies,  nicotin  was  the  agent  used.  An  un- 
known quantity  was  forcibly  put  into  the  throat  of  the 
victim,  the  Countess  assisting  her  husband  as  an  accom- 
plice in  the  murder.  Death  was  beheved  to  have  taken 
place  within  five  minutes.  The  poison  was  detected  by 
Stas  in  the  tongue,  throat,  stomach,  liver,  and  spleen  of  the 
deceased,  and  also  from  stains  on  the  floor  near  where  the 
act  was  committed.  From  the  excellent  report  of  the  ex- 
amination of  Stas,  we  may  note  the  following  particulars  : 
The  appearance  of  the  tongue  indicated  the  action  of  some 
highly  acrid  agent ;  it  was  swollen,  blackened,  softened 
and  friable ;  the  epithelium  was  easily  detached.  This  was 
also  the  condition  of  the  mucous  lining  of  the  mouth  and 
pharynx ;  it  was  reddened  as  if  cauterized,  and  easily 
separated.  The  lining  membrane  of  the  stomach  was  in- 
tensely injected,  exhibiting  large  patches  which  were  livid 
and  black.  The  vessels  were  filled  with  a  black  coagulum 
resembling  blood  that  had  been  treated  with  sulphuric  acid. 
The  duodenum  was  also  highly  injected.     There  were  no 


NICOTIN ANALYTIC    METHODS.  617 

ulcerations  or  perforations  of  the  stomach  and  bowels. 
The  lungs  were  gorged  with  black  blood  and  exhibited  the 
usual  character  of  asphyxia.  The  heart  was  normal ;  its 
cavities  contained  black,  liquid  blood.  No  odor  was  ob- 
served in  the  body. 

Analytic  Methods.  —  If  a  drop  be  put  into  a  watch-glass, 
and  this  be  covered  with  another  glass  inverted,  containing 
a  drop  of  either  nitric  or  hydrochloric  acid,  the  glass  will 
become  filled  with  white  fumes,  not  so  dense  as  from  co- 
nin,  nor  do  they  give  rise  to  the  formation  of  ciystals. 
Tfie  strong  acids  applied  directly  to  it  produce  no  charac- 
teristic effects. 

Nicotin  unites  freely  with  acids,  forming  salts,  which  do 
not  readily  crystallize,  retaining  the  peculiar  taste  of  the 
alkaloid,  but  are  destitute  of  odor.  They  are  mostly  solu- 
ble in  water  and  alcohol,  but  not  in  ether  or  chloroform. 

1.  Platinum  chlorid  throws  down  a  yellow  precipitate, 
which  becomes  crystalline  seen  under  the  microscope,  and 
is  soluble  in  hydrochloric  acid. 

2.  Mercuric  chlorid  gives  a  white  crystalline  precipitate, 
changing  to  yellow.  These  crystals  assume  a  pecuHar, 
beautiful  appearance  in  groups  of  various  patterns.  These 
are  distinguished  from  the  precipitates  caused  by  this  same 
reagent  with  ammonium  hydroxid  and  the  other  alkaloids, 
by  the  fact  that  the  latter  are  amorphous,  except  that  of 
stiychnin,  but  which  last  is  wholly  unlike  that  produced  by 
nicotin.     This  is  a  very  delicate  test. 

3.  Gold  chlorid  yields  a  yellow  amorphous  precipitate, 
which  is  not  characteristic. 

4.  Picric  acid  gives  a  yellow  amorphous  precipitate, 
which  ultimately  assumes  the  form  of  a  crystalline  tuft,  to 
be  viewed  by  the  microscope. 

52 


6l8  TOXICOLOGY. 

5.  By  adding  to  an  ethereal  solution  of  nicotin  a  solution 
of  iodin  in  ether,  beautiful  long,  needle-like  crystals  form 
after  some  hours. 

Toxicologic  Examination. — The  stomach  and  other  organs, 
properly  prepared,  may  be  subjected  to  the  process  of  Stas. 
In  fact,  it  was  the  process  employed  by  its  originator  in  the 
Bocarme  case  above  alluded  to.  Other  good  authorities 
have  somewhat  simplified  his  process.  Water  may  be  em- 
ployed as  the  solvent,  instead  of  alcohol ;  and  either  acetic, 
sulphuric,  or  tartaric  acid  may  be  used.  After  proper  con- 
centration and  filtration  it  should  be  supersaturated  with 
sodium  hydroxid  and  shaken  up  with  chloroform  or  ether, 
and  these  solutions,  when  properly  separated,  allowed  to 
evaporate  spontaneously  on  watch-crystals,  when  the  nico- 
tin, if  present,  will  be  seen  in  the  form  of  drops  or  oily 
streaks,  having  the  peculiar  odor  of  the  alkaloid,  which  is 
rendered  more  distinct  by  heating.  This  should  be  dis- 
solved in  a  few  drops  of  water  and  the  appropriate  tests 
applied.  A  drop  or  two  may  also  be  given  to  a  small 
animal.  Nicotin  inserted  under  the  skin  of  a  frog  produces 
peculiar  muscular  movements,  attended  with  tetanic  con- 
vulsions, slowing  of  the  heart's  action,  and  of  respiration. 

It  causes  death  most  probably  by  paralyzing  the  respira- 
toiy  nerve  centers. 

Nicotin  has  been  detected  in  the  tissues  several  months 
after  death.  Wormfey  procured  it  from  the  blood  of  two 
cats,  each  poisoned  by  a  drop  placed  upon  the  tongue,  the 
animals  having  died  in  seventy-five  seconds  and  in  two  and 
a  half  minutes,  respectively. 

A  ptomain  has  been  described  possessing  many  of  the 
properties  of  nicotin,  but  it  is  not  poisonous,  nor  does  it 
respond  to  the  usual  tests  of  nicotin. 


LOBELiN.  619 

Lobelia. — The  Lobelia  inflata,  or  Indian  Tobacco,  is  a 
native  of  this  country,  belonging  to  the  natural  order 
LobeliacecB.  It  is  extensively  used  both  here  and  in  Great 
Britain  in  proprietary  and  domestic  medicine.  According 
to  Letheby,  thirteen  cases  of  poisoning  by  this  substance 
had  occurred  in  England  within  three  or  four  years,  and 
Beck  states  that  "  thousands  of  individuals  in  the  United 
States  have  been  murdered  by  the  combined  use  of  capsi- 
cum and  lobelia  administered  by  the  Thomsonian  quacks." 
The  leaves  and  seeds  are  the  parts  employed.  They  owe 
their  activity  to  a  fixed  alkaloid  named  lobelin. 

Symptoms.  —  In  small  doses  lobelia  acts  as  an  expec- 
torant, in  large  doses  as  an  emetic  and  depressant.  In 
poisonous  doses  it  produces  distressing  nausea  and  vomit- 
ing, sometimes  purging,  extreme  relaxation,  cold  sweats, 
small,  feeble  Impulse,  great  prostration,  contracted  pupils, 
stupor,  occasionally  convulsions,  coma,  and  death  —  symp- 
toms strikingly  like  those  caused  by  tobacco.  A  drachm 
of  the  powdered  leaves  has  proved  fatal. 

The  post-mortem  appeara}ices  are  very  similar  to  those 
caused  by  tobacco. 

Lobelin,  the  active  alkaloid  principle,  is  a  yellowish  liquid, 
lighter  than  water,  of  a  somewhat  aromatic  odor,  and  acrid, 
persistent  taste  ;  soluble  in  water,  more  so  in  alcohol  and 
ether;  has  an  alkaline  reaction,  forming  soluble  salts  with 
acids.  Tannin  precipitates  it  from  its  solutions.  It  resembles 
nicotin  in  most  of  its  properties.  On  animals,  lobelin  seems 
to  produce  the  narcotic,  but  not  the  emetic  effects  of  the 
plant. 

No  case  is  recorded  of  death  from  lobelin.  In  the  inves- 
tigation of  a  case  of  death  from  lobelia  the  diagnosis  would 


620  ^  TOXICOLOGY. 

be  materially  aided  by  the  discovery  of  fragments  of  the 
leaves  or  of  the  seeds. 

SPOTTED   HEMLOCK. 

The  Conium  inaailatitm,  or  spotted  hemlock,  is  believed 
to  be  the  same  plant  as  the  Ciciita  of  the  ancient  Greeks, 
that  furnished  the  poison  by  which  Socrates  perished.  All 
parts  are  poisonous ;  the  leaves  and  root  are  employed  in 
medicine,  in  the  form  of  fresh  juice  and  extract.  It  belongs 
to  the  natural  order  Umbelliferce,  which  also  includes  many 
other  poisonous  plants. 

Poisoning  by  hemlock  is  generally  the  result  of  accident, 
the  fresh  leaves  being  used  in  soup  in  mistake  for  parsley, 
which  it  somewhat  resembles.  Its  action  on  man  appears 
to  be  very  variable  —  at  least  the  accounts  are  very  diverse. 

Symptoms.  —  Headache,  imperfect  vision,  dilated  pupils, 
difficulty  of  swallowing,  drowsiness,  a  tingling  sensation 
along  the  muscles,  gradually  complete  paralysis  of  the  ex- 
tremities ;  this  extends  finally  to  the  muscles  of  respiration, 
and  the  patient  dies,  at  last,  from  apnea.  If  death  be 
delayed  for  some  time,  there  may  be  convulsions,  coma, 
violent  delirium,  accompanied  with  salivation,  and  involun- 
tary discharges  from  the  bladder  and  bowels.  Death  usually 
takes  place  in  one  to  three  hours.  One  drop  of  conin  is 
considered  to  be  a  poisonous  dose.  The  treatment  consists 
in  a  prompt  evacuation  of  the  stomach  by  emetics  or  the 
use  of  the  stomach-pump,  followed  by  castor  oil  and 
stimulants. 

Post-mortem  Appearances. — These  are  not  at  all  charac- 
teristic, redness  of  the  mucous  membrane  of  the  stomach 
and  congestion  of  the  lungs  being  usually  observed.  Frag- 
ments of  the  leaves  and  the  seeds  (if  these  have  been  swal- 


CONIN TESTS.  62  I 

lowed)  may  often  be  recognized  in  the  stomach  and  bowels 
with  the  aid  of  the  microscope.  If  the  leaves  be  rubbed  in 
a  mortar  with  sodium  hydroxid,  they  emit  a  peculiar  mousy 
odor. 

Conin.  —  This  alkaloid  exists  most  abundantly  in  the 
seeds.  It  is  one  of  the  most  powerful  and  fatal  poisons 
known.  Christison  states  that  a  single  drop,  applied  to  the 
eye  of  a  rabbit,  killed  it  in  nine  minutes  ;  and  three  drops, 
applied  in  the  same  manner,  killed  a  strong  cat  in  a  minute 
and  a  half.  In  Wormley's  experiments,  a  single  drop 
placed  upon  the  tongue  of  a  large  cat  caused  the  animal  at 
first  to  stand  still ;  in  two  minutes  and  a  half  it  fell  upon  its 
side,  voided  urine,  had  violent  convulsions  of  the  limbs, 
with  trembling  of  the  body,  when  it  died  in  three  minutes 
from  the  time  of  administration. 

Tr'eatinent.  —  Prompt  emesis,  to  get  rid  of  the  poison,  and 
active  stimulation.  Strychnin  has  been  suggested  as  a 
physiological  antidote,  but  it  is  too  dangerous  a  substance 
to  be  employed  for  this  purpose  without  excessive  care. 

Properties.  —  Conin  is  a  colorless,  volatile,  oily  liquid  ; 
sp.  gr.  0.886  ;  the  odor  is  peculiar,  repulsive,  and  suffoca- 
tive. Diluted  with  water  it  emits  an  odor  resembling  mice. 
It  gives  a  greasy  stain  to  paper,  and  burns  with  a  bright, 
smoky  flame  ;  taste  disagreeable  and  permanent.  It  is  a 
strong  base,  forming  with  acids  crystalline  salts.  Exposed 
to  the  air  it  becomes  yellowish  and  resinoid.  It  is  partially 
soluble  in  water,  freely  so  in  alcohol,  ether,  and  chloroform  ; 
the  two  latter  will  separate  it  from  its  aqueous  solutions. 

Tests. — A  drop  is  placed  in  a  watch-glass  and  covered 
over  with  a  precisely  similar  glass,  holding  a  drop  of  pure 
hydrochloric  acid  on  its  under  surface  ;  both  glasses  imme- 


622  TOXICOLOGY. 

diately  become  filled  with  dense  white  fumes,  and  the  drop 
of  conin  is  converted  into  a  mass  of  beautiful,  delicate  crys- 
talline needles,  which  do  not  deliquesce  in  the  air.  Sul- 
phuric acid  imparts  to  it  a  pale-red  color.  Nitric  acid 
causes  with  it  dense  white  fumes.  Strong  hydrochloric 
acid  imparts  to  it  a  faint  tint,  which  gradually  becomes 
much  deeper,  and  on  evaporation  needle-shaped  crystals 
appear.  Like  other  alkaloids,  it  yields  precipitates  with 
tannin,  mercuric  chlorid,  gold  chlorid,  platinum  chlorid, 
potassium  iodid,  etc.  By  oxidation,  conin  is  converted  into 
butyric  acid.  A  crystal  of  potassium  dichromate  is  put 
into  a  test-tube  with  some  diluted  sulphuric  acid,  together 
with  the  suspected  conin.  On  heating,  the  peculiar  odor 
of  butyric  acid  is  revealed.  Another  test  is  alloxan.  If 
dropped  into  a  solution  of  this  substance,  an  intense  purple- 
red  color  is  developed,  and  white  needle-shaped  crystals 
appear.  Its  liquid,  oily  condition,  together  with  its  peculiar 
odor,  will  distinguish  it  from  all  other  bodies  except  nicotin  ; 
and  the  points  of  difference  between  the  two  are  mentioned 
in  the  article  on  nicotin. 

Toxicologic  Examination.  —  Search  first  for  any  remains 
of  leaves,  or  of  seeds,  in  the  stomach  and  intestines,  and 
avoid  mistaking  the  leaves  of  parsley  for  those  of  hemlock. 
Rub  the  leaves  in  a  mortar  with  potassa,  to  develop  the 
peculiar  mousy  smell.  Then  distill,  and  examine  the  dis- 
tillate before  employing  the  more  elaborate  process  of  Stas. 
Water  and  acetic  acid  may  be  employed  as  the  proper  sol- 
vents ;  evaporate  the  filtered  solution  to  a  syrupy  consist- 
ence, mix  with  strong  alcohol  and  a  few  drops  of  acetic 
acid,  filter  again  and  evaporate  to  near  dryness  ;  add  a  little 
distilled  water,  supersaturate  with  solution  of  sodium  hy- 
droxid,  and  agitate  with  ether,  repeating  the  process  several 


ACONITE.  623 

times.  Remove  the  ether  and  allow  it  to  evaporate  spon- 
taneously. Dilute  the  alkaloid  and  subject  it  to  the  appro- 
priate tests. 

A  conin-like  ptomain  has  been  discovered,  having  very 
poisonous  properties,  but  differing  from  conin  in  its  reac- 
tions. 

It  is  necessary  to  guard  against  too  much  reliance  upon 
the  supposed  odor  of  conin.  Sodium  hydroxid  may  often 
develop  an  odor  from  organic  substances  which  might  pos- 
sibly be  mistaken  for  that  of  conin.  Nothing  short  of  the 
isolation  of  this  principle,  in  a  search  for  the  poison,  will  be 
satisfactory. 

Other  hemlocks,  viz.,  Ciciita  virosa,  or  water  hemlock, 
and  CEnanthe  crocata,  are  all  very  poisonous  ;  this  is  espe- 
cially true  of  the  CE.  crocata,  which  is  one  of  the  most 
poisonous  of  the  Umbelliferce.  Children  are  occasionally 
poisoned  by  wild  Umbelliferse,  the  exact  species  being  fre- 
quently uncertain,  partly  because  early  growths  of  these 
plants  rarely  possess  characteristic  features,  and  partly 
because  it  is  often  impossible  to  secure  specimens  or  clear 
descriptions  of  the  plants  eaten.  The  common  parsnip, 
Pastinaca  sativa,  and  even  the  common  carrot,  Dauciis 
carota,  are  abundant  in  the  wild  state  and  are  suspected  of 
being  more  poisonous  than  in  the  cultivated  forms.  The 
tree  known  as  hemlock  (hemlock-spruce)  has  no  botanical 
resemblance  to  water-hemlock  and  is  not  poisonous. 

ACONITE. 
Aconite.  — The  Aconitum  napellus  (Monkshood  or  Wolfs- 
bane) is  indigenous  in  Europe,  but  is  cultivated  in  this  coun- 
try. It  grows  from  two  to  four  or  five  feet  high,  and  has  a  spike 
of  rich  blue  flowers.     All  parts  of  it  are  poisonous,  the  root 


624  TOXICOLOGY. 

most  so,  depending  on  the  presence  of  the  alkaloid  aconitin. 
The  root  is  tapering,  carrot-like,  two  or  three  inches  long, 
having  a  number  of  curly  fibers  passing  off  from  it.  This 
root  has  frequently  been  mistaken  for  the  root  of  the  horse- 
radish, from  which,  however,  it  differs  essentially  in  appear- 
ance ;  the  latter  being  long  and  cylindrical  and  truncated, 
not  tapering,  of  a  light-brown  color  externally,  white  inter- 
nally, and  of  a  sweetish,  hot,  and  pungent  taste,  totally  dis- 
tinct from  that  of  aconite,  which  imparts  to  the  lips,  tongue, 
and  fauces  a  peculiar  tingling,  numbing  sensation,  which  is 
very  persistent. 

There  is  considerable  diversity  in  the  activity  of  different 
specimens  of  aconite,  depending,  doubtless,  on  the  time  and 
modes  of  collecting  and  drying  of  the  plant,  and  probably 
also  on  the  place  of  growth.  This  may  account  for  the  dis- 
cordant results  obtained  by  different  investigators. 

Aconite  root  has  been  administered  criminally  in  at  least 
one  recorded  case,  where  the  powdered  root  was  mixed 
with  pepper,  and  sprinkled  over  the  greens  used  for  dinner 
by  the  deceased. 

Symptoms.  —  There  is  first  a  dryness  of  the  throat,  accom- 
panied with  tingling  and  numbness  of  the  lips,  throat,  and 
tongue,  followed  by  nausea  and  vomiting,  with  pain  and 
tenderness  of  the  epigastrium.  The  numbness  and  tingling 
now  become  more  general,  with  diminution  or  loss  of  sensi- 
bility of  the  surface,  vertigo,  dimness  of  vision,  tinnitus 
aurium,  with  occasional  deafness,  frothing  at  the  mouth, 
sense  of  constriction  of  the  throat,  great  muscular  prostra- 
tion, inability  to  walk,  a  slow,  feeble  pulse,  difficulty  of 
breathing,  a  cold,  clammy  skin,  dilated  pupils,  features 
pale,  perhaps  a  few  convulsions,  followed  by  death.  The 
mind  usually  remains  clear  to  the  last.     Delirium  is  rare. 


ACONITIN.  625 

Death  is  apt  to  be  sudden,  either  from  shock,  asphyxia,  or 
syncope. 

Post-mortem  Appearances.  —  There  is  nothing  character- 
istic. There  is  usually  general  venous  congestion  of  all  the 
organs,  especially  the  brain,  lungs,  and  liver ;  there  may  be 
redness  of  the  lining  membrane  of  the  stomach  ;  the  blood 
is  generally  fluid  and  dark  in  color;  the  heart  may  continue 
beating  for  a  little  while  after  death,  indicating  that  this  was 
caused  by  asphyxia.  In  other  cases  the  death  may  be  as- 
cribed to  syncope. 

The  fatal  dose  is  undetermined  in  consequence  of  the 
diversity  in  the  strength  of  the  different  preparations  of  the 
drug.  An  excise  officer  in  England  died  in  a  few  hours 
after  merely  tasting  Fleming's  strong  tincture.  Pereira 
speaks  of  a  case  in  which  two  doses  of  six  drops  each  of 
the  tincture  of  the  root,  taken  at  an  interval  of  two  hours, 
produced  most  alarming  symptoms  in  a  young  man  ;  and 
Wormley  alludes  to  an  instance  in  which  five  drops  of 
Thayer's  fluid  extract  of  the  root  produced  most  serious 
effects,  which  continued  for  two  hours. 

The  symptoms  may  come  on  almost  immediately  or  be 
delayed  for  an  hour  or  two.  Death  generally  occurs  within 
three  or  four  hours ;  but  it  may  be  deferred,  as  in  other 
poisons,  for  twenty-four  hours. 

Aconitin.  — The  active  alkaloid  principle,  abounding  most 
in  the  root,  of  which  it  constitutes  about  one  tenth  to  one 
fifth  of  one  per  cent.  It  is  one  of  the  most  powerful  poisons 
known.  Pereira  states  that  one  fiftieth  of  a  grain  nearly 
proved  fatal  to  an  elderly  lady.  Much  of  the  aconitin  as 
sold  in  the  shops  is  totally  inert  and  worthless.  This  poison 
has  lately  been  brought  prominently  into  notice  in  the  case 


626  TOXICOLOGY. 

of  Dr.  Lamson,  who  used  it  in  destroying  his  brother-in-law 
in  England  some  years  ago. 

Treatment.  —  There  is  no  active  direct  antidote.  The 
stomach  should  be  immediately  emptied  by  the  stomach- 
pump  or  an  active  emetic.  Animal  charcoal  is  recommended 
by  Headland  ;  also  tannin  or  astringent  infusions.  Slight 
galvanic  shocks  are  recommended  to  be  passed  through  the 
heart,  in  order  to  arouse  its  action  ;  also  the  employment  of 
artificial  respiration.  Possibly  the  inhalation  of  oxygen  might 
be  of  some  advantage. 

As  strychnin  and  aconitin  seem  to  have  some  antagonistic 
action,  it  might  be  well  to  employ  the  former  cautiously  in 
the  treatment  of  poisoning  by  the  latter.  A  case  has  been 
reported  in  which  the  recovery  of  a  child  was  apparently 
due  to  two  doses  of  tincture  of  nux  vomica,  administered 
twenty  minutes  apart. 

It  appears  that  digitalis  may  possess  an  antidotal  power 
over  aconitin.  Fothergill  discovered  that  digitalis,  admin- 
istered to  frogs  that  were  under  the  influence  of  aconite,  re- 
lieved the  heart  from  the  depression  produced  by  the  latter 
poison,  recalling  its  normal  movements.  A  case  is  reported 
in  which  recovery  took  place  in  a  man  who,  when  intoxicated, 
had  swallowed  an  ounce  of  Fleming's  tincture.  The  patient 
was  apparently  dying,  when  twenty  minims  of  tincture  of 
digitalis  were  injected  subcutaneously,  and  after  twenty 
minutes  the  patient  had  recovered  sufficiently  to  swallow, 
when  a  fluid  drachm  of  the  tincture  was  given,  along  with 
brandy  and  ammonium  hydroxid,  and  was  twice  repeated 
within  an  hour.  The  above  statement  suggests  the  cautious 
employment  of  this  remedy  in  a  case  of  aconite  poisoning. 

Analytic  Methods. — Aconitin,  when  pure,  is  in  colorless, 
transparent  crystals,  but  as  found  in  the  shops  it  is  usu- 


ACONITIN TOXICOLOGIC    EXAMINATION.  627 

ally  an  amorphous  powder.  Many  samples  are  inert.  The 
taste  is  at  first  acrid,  soon  followed  by  tingling  and  numb- 
ness of  the  lips  and  tongue.  Its  solution,  applied  to  the 
skin,  occasions  a  feeling  of  heat  and  numbness.  So  active 
is  this  poison  that,  according  to  Stevenson,  one  three-thou- 
sandth of  a  grain  of  Morson's  aconitin  will  destroy  a  mouse. 
The  one  thousandth  of  a  grain  produces  tingling  and  numb- 
ness of  the  lips  and  tongue  when  applied  to  the  tip  of  the 
latter  organ  ;  and  one  hundredth  of  a  grain,  dissolved  in 
spirit  and  rubbed  into  the  skin,  causes  a  loss  of  feeling 
lasting  for  some  time. 

It  has  strong  basic  properties,  forming  salts  with  acids, 
which  are  mostly  soluble.  It  is  very  slightly  soluble  in 
water,  quite  soluble  in  alcohol  and  chloroform,  but  insoluble 
in  ether.  None  of  the  mineral  acids  changes  it  in  the  cold  ; 
but  warm  sulphuric  acid  imparts  to  it  a  brown  tint.  There 
is  no  characteristic  analytic  test  for  it.  Its  presence  can 
usually  only  be  satisfactorily  established  by  the  physiologic 
test  —  the  peculiar  tingling,  benumbing  sensation  imparted 
to  the  mouth  and  tongue  when  a  minute  fragment  of  the 
ultimate  extract  is  tasted,  or  by  a  similar  application  to  the 
skin,  attended  with  similar  results,  together  with  its  intro- 
duction into  some  small  animal,  hypodermically. 

If  the  poisoning  has  occurred  from  swallowing  the  leaves 
or  root  of  the  plant,  a  careful  microscopic  inspection  of  the 
stomach  and  bowels,  and  of  the  matters  vomited  and  purged, 
should  be  instituted,  in  order  to  identify  their  botanical 
characters. 

Toxicologic  Examination.  —  A  modification  of  Stas'  process 
should  be  employed,  similar  to  that  described  for  nicotin. 
Chloroform  is  preferable  as  the  final  solvent.  The  residue 
thus  obtained  should  be  dissolved  in  a  few  drops  of  pure 


628  TOXICOLOGY. 

water,  slightly  acidified  with  acetic  acid  and  submitted  to 
the  physiological  tests  above  described.  If  these  afford  no 
satisfactory  results,  no  mere  analytic  tests  can  be  relied  on  ; 
but  if  they  give  evidence  of  the  presence  of  the  poison,  then 
the  solution  should  be  subjected  to  all  the  known  reactions, 
such  as  picric  acid,  platinum  chlorid,  gold  chlorid,  and  the 
bromin  test. 

CALABAR  BEAN. 

The  Ordeal  Bean  of  Calabar  {Physostiguia  venenosiiin)  is 
a  large  leguminous  seed,  about  an  inch  and  a  half  long,  and 
of  a  brownish-black  color.  It  is  used  by  the  natives  of  the 
West  Coast  of  Africa  as  the  ordeal  test  for  witchcraft  —  the 
suspected  person  being  compelled  to  drink  a  decoction  of 
the  poisonous  beans.  It  owes  its  activity  to  the  alkaloid 
named  eserin,  which  resides  in  the  cotyledons.  These, 
when  touched  with  nitric  acid,  assume  an  orange  tint,  and 
with  ferric  chlorid  a  brown  one.  The  alkaloid  is  a  color- 
less, crystalline  solid,  bitter  to  the  taste,  veiy  slightly 
soluble  in  water  ;  soluble  in  alcohol,  ether,  chloroform, 
and  benzene. 

Bromin  in  potassium  bromid  produces  with  it  a  red  color. 
It  gives  this  color  with  less  than  -^^-^-^  of  a  grain.  Accord- 
ing to  Dr.  J.  B.  Edwards  it  reacts  with  sulphuric  acid  and 
potassium  dichromate  very  much  like  strychnin  —  produc- 
ing the  play  of  colors  ;  this,  however,  needs  further  confir- 
mation. 

The  action  of  this  poison  upon  the  lower  animals  is  that 
of  a  spinal  depressant,  causing  at  first  tremors  and  then 
paralysis,  with  muscular  flaccidity  ;  contraction  of  the  pupils  ; 
respiration  slow,  irregular,  and  stertorous  ;  sometimes  there 
are  convulsions.  The  heart  is  found  to  beat  for  some  time 
after  death.      Consciousness  is  preserved  throughout. 


CALABAR    BEAN.  629 

The  effects  on  man  are  similar  to  the  above.  They  are 
the  opposite  to  those  produced  by  strychnin,  which  is  a 
true  spinal  excitant.  For  this  reason  it  has  been  employed 
as  a  remedy  for  tetanus,  and  also  as  an  antidote  for  strychnin. 

Its  most  characteristic  physiological  action  is  the  property 
of  contracting  the  pupil,  which  at  once  distinguishes  it  from 
belladonna,  as  also  from  conin  and  curarin,  which  it  resem- 
bles in  some  particulars. 

The  true  physiological  antidote  is  atropin,  used  hypo- 
dermically,  and  repeated  until  expansion  of  the  pupil  is 
manifested.  From  the  experiments  of  Dr.  Fraser  and 
others  there  can  be  no  doubt  of  the  mutual  antagonism  of 
atropin  and  eserin. 

The  most  satisfactoiy  test  is  the  physiological  one  —  its 
power  to  contract  the  pupil.  A  drop  or  two  of  the  sus- 
pected fluid  is  put  into  the  eye  of  a  rabbit  or  other  small 
animal,  and  in  the  course  of  fifteen  or  twenty  minutes  the 
characteristic  impression  will  be  observed. 

Dragendorff  has  succeeded  in  separating  it  from  the 
tissues  by  a  modification  of  Stas'  process,  employing  ben- 
zene instead  of  ether  as  the  ultimate  solvent. 

A  boy,  aged  six  years,  died  from  eating  six  of  the  beans. 

Another  subdivision  of  Cerebro-spinants  comprises  those 
Neurotics  which  destroy  hfe  by  asthenia,  or  failure  of  the 
heart's  action.  It  is  not  intended  to  assert  that  they  may 
not  prove  fatal  in  some  cases  in  another  manner,  as,  e.  g., 
through  shock  or  asphyxia.  But  as  the  most  strongly- 
marked  symptoms  are  those  of  heart  failure,  this  name 
answers  sufficiently  well  for  grouping  together  those  neu- 
rotic poisons  that  especially  display  this  property.  The 
two   most  important  members  of  this   group   are    Hydro- 


630  TOXICOLOGY. 

cyanic  Acid  and  Digitalis.      For  convenience  Cocculus  In- 
dicus  is  considered  under  the  same  head. 

HYDROCYANIC   ACID. 

Hydrocyanic  Acid  (Hydrogen  Cyanid,  Prussic  Acid)  is 
one  of  the  most  energetic  and  rapidly  fatal  poisons  known. 
It  may  be  obtained  from  many  plants  of  the  order  RosacecE, 
such  as  bitter  almonds,  kernels  of  the  peach,  apricot,  plum, 
and  cherry,  pips  of  apples,  and  the  flowers  and  leaves  of  the 
peach  and  cherry-laurel.  From  the  latter  a  very  poisonous 
liquid  is  prepared.  Hydrogen  cyanid  does  not  preexist  in 
these  vegetable  substances,  but  is  the  product  of  the  reac- 
tion, in  the  presence  of  water,  of  an  unorganized  ferment 
upon  complex  nitrogenous  bodies.  In  the  most  familiar 
instance,  that  of  the  bitter  almond,  the  result  is  due  to  the 
action  of  a  ferment  called  synaptase  upon  a  body  called 
amygdalin.  The  process  is  quite  analogous  to  ordinary 
digestion.  Under  the  influence  of  the  ferment,  water  is 
taken  up  by  the  amygdalin,  which  then  decomposes  into 
glucose,  benzaldehyd  and  hydrogen  cyanid. 

Hydrogen  cyanid  is  a  colorless,  limpid  liquid,  extremely 
volatile,  and  having  the  odor  recalling  that  of  bitter  almonds. 
A  single  drop  placed  upon  the  tongue  of  a  large  dog  has 
caused  death  in  a  few  seconds.  The  pure  acid  is  rarely  met 
with  except  in  the  laboratory.  The  dilute  or  medicinal  acid 
is  frequently  the  cause  of  death.  This  latter  is  merely  a 
solution  of  the  pure  acid  in  water,  and  occurs  in  the  shops 
under  two  different  forms:  (1)  The  official  acid,  of  the 
average  strength  of  two  per  cent.;  and  (2)  Scheele's  acid, 
of  the  average  strength  of  five  per  cent.  The  strength  of 
both  varieties  varies  considerably,  and  it  is  not  uncommon 
to   find  some   specimens   totally   inert,   probably  from   the 


HYDROCYANIC    ACID FATAL    PERIOD.  63  I 

liability  of  the  acid  to  undergo  decomposition  when  exposed 
to  the  light.  The  dilute  acid  is  colorless,  and  has  the  odor 
of  bitter  almonds,  and  a  hot,  pungent  taste.  The  French 
acid  has  a  strength  of  ten  per  cent. 

Symptojns. — These  vary  with  the  size  of  the  dose.  A 
large  dose  —  half  an  ounce  to  an  ounce  of  the  diluted  acid  — 
may  produce  symptoms  in  the  act  of  swallowing,  or  in  a 
few  seconds  after.  They  are  seldom  delayed  beyond  one 
or  two  minutes.  Tardieu  describes  them  as  "  coming  with 
lightning-like  rapidity."  There  is  an  immediate  loss  of 
muscular  power  with  giddiness ;  the  person  staggers  and 
falls  to  the  ground  ;  the  respiration  becomes  hurried  and 
gasping ;  the  pulse  imperceptible ;  the  eyes  glassy  and 
protruding ;  the  pupils  dilated  and  insensible  to  light ; 
the  extremities  cold ;  and  sometimes  convulsions  occur. 
Toward  the  last  the  breathing  is  performed  convulsively,  in 
sobs.  Sometimes  the  bladder  and  rectum  are  evacuated 
involuntarily.  The  face  is  pallid ;  the  jaws  spasmodically 
closed  ;  there  is  frothing  at  the  mouth,  occasionally  bloody  ; 
often  the  peculiar  odor  of  the  poison  can  be  detected  in  the 
breath  ;  death  occurs  sometimes  in  a  violent  convulsion,  at 
others  it  is  preceded  by  coma,  with  stertorous  breathing. 
The  last  symptom  is  of  considerable  importance,  since  it 
might  easily  lead  to  a  mistaken  diagnosis  for  apoplexy.  In 
animals  poisoned  by  this  substance  a  peculiar  cry  is  often 
heard,  but  this  does  not  occur  with  human  beings. 

Fatal  Period. — Death  generally  occurs  within  ten  or  fif- 
teen minutes  after  swallowing  the  poison.  Rarely  is  it 
protracted  for  half  an  hour.  One  case  is  recorded  where 
an  hour  supervened.  Insensibility  is  not,  however,  always 
immediate ;  instances  are  recorded  of  persons,  after  swal- 
lowing very  large  and  fatal  doses  of  this  poison,  performing 


632  TOXICOLOGY, 

many  voluntary  acts,  such  as  walking  into  another  room, 
opening  drawers,  going  down  stairs,  etc. 

The  symptoms  attendant  on  a  large  but  not  fatal  dose 
are  confusion  of  head,  giddiness,  a  sense  of  weight  upon  the 
brain,  great  muscular  debility,  nausea,  vomiting,  possibly 
convulsions,  and  oppressed  breathing.  Several  days  may 
elapse  before  complete  recovery  takes  place. 

Application  to  the  skin,  especially  if  abraded,  may  occa- 
sion fatal  consequences.  Christison  reports  a  case  in  which 
the  liquid,  applied  to  a  wound  in  the  hand,  caused  death  in 
one  hour. 

Fatal  Quantity.  —  The  minimum  fatal  dose  for  an  adult 
may  be  taken  to  be  about  fifty  minims  of  the  official  prepa- 
ration, which  is  equivalent  to  nine  tenths  of  a  grain  of  anhy- 
drous acid.  The  largest  dose  from  which  a  recovery  has 
been  reported  was  one  drachm  of  Scheele's  acid,  equivalent 
to  2.4  grains  of  hydrogen  cyanid.  Other  instances  are  re- 
ported of  recovery  after  taking  doses  equivalent  to  two 
grains  and  under,  in  all  of  which  prompt  and  vigorous 
measures  were  adopted.  The  inhalation  of  the  vapor  is 
exceedingly  dangerous,  and  has  even  proved  fatal. 

Treatment. — So  rapid  are  the  poisonous  effects  on  the 
body  that  there  is  scarcely  any  opportunity  for  the  employ- 
ment of  remedies.  The  cold  affusion,  by  dashing  cold 
water  over  the  face  and  chest,  should  be  at  once  employed. 
This  should  be  followed  by  the  cautious  inhalation  of  diluted 
ammonium  hydroxid  and  chlorin,  along  with  stimulants 
applied  both  internally  and  externally.  As  a  chemical  an- 
tidote, a  mixture  of  ferrous  and  ferric  sulphates,  followed 
by  a  solution  of  potassium  carbonate,  has  been  proposed ; 
this  would  produce  with  hydrogen  cyanid  in  the  stomach 
Prussian   blue  —  an  inert  compound.     The  experiment  has 


HYDROCYANIC    ACID POST-MORTEM    APPEARANCES.    633 

proved  successful  with  animals.  Hydrogen  dioxid  (com- 
monly called  hydrogen  peroxid)  decomposes  cyanids  com- 
pletely, but  the  action  is  too  slow  to  be  available  in  cases  of 
poisoning.  Cobalt  compounds  at  once  render  cyanids  inert, 
but  these  are  themselves  irritant  poisons  and  are  not  ordi- 
narily obtainable.  Still  the  poisonous  action  of  a  small 
amount  of  freshly  precipitated  cobalt  hydroxid  would  prob- 
ably be  slight  and  estabhshments  in  which  cyanids  are  much 
used  might  keep  on  hand  a  solution  of  cobalt  sulphate  and 
sodium  hydroxid,  with  directions  for  mixing  and  adminis- 
tering. 

Post-mortem  Appearances.  — The  face  is  pale  or  livid  ;  the 
eyes  often  glistening  and  staring,  with  the  pupils  dilated  ; 
the  lips  blue,  jaws  firmly  set,  with,  at  times,  a  bloody  froth 
issuing  from  the  mouth.  The  blood  is  of  a  dark  blue  color 
and  fluid.  The  cerebral  vessels  are  congested.  Tardieu 
alludes  to  effusions  of  blood  and  serum  at  the  base  of  the 
brain,  as  an  occasional  occurrence,  which  might  suggest 
apoplexy ;  this,  however,  is  negatived  by  the  absence  of 
hemiplegia,  and  by  the  rapidity  of  the  death.  There  is 
congestion  of  the  lungs  and  liver ;  and  the  mucous  mem- 
brane of  the  stomach,  especially  about  the  cardiac  ex- 
tremity, is  apt  to  be  much  reddened. 

The  exhalation  of  the  pecuHar  odor  is  one  of  the  most 
important  post-mortem  characters.  This  odor  is  sometimes 
perceived  even  before  the  body  is  opened,  in  recent  cases, 
but  it  is  particularly  noticeable  in  opening  the  abdomen  and 
thorax,  and  even  the  brain,  and  especially  the  stomach. 
As  the  poison  is  very  volatile,  it  may  happen  that  the  odor 
will  have  disappeared  even  in  a  few  hours,  if  the  body  has 
been  much  exposed.  There  is  a  singular  variation  in  this 
respect  in  different  cases.  Moreover,  the  odor  may  be  dis- 
53 


634  TOXICOLOGY. 

guised  by  other  more  powerful  smells,  such  as  tobacco, 
mint,  etc.  The  mere  absence  of  odor,  is,  therefore,  no 
proof  of  the  non-existence  of  the  poison. 

Analytic  Methods.  —  There  are  four  recognized  tests  for 
hydrocyanic  acid,  which  may  be  briefly  designated  as  the 
silver,  iron,  sulphur,  and  copper  tests.  The  first  three  are 
characteristic,  and  they  may  be  applied  either  to  the  liquid 
or  vapor. 

I.  The  Silver  Test.  —  A  solution  of  any  cyanid  gives,  with 
a  solution  of  silver  nitrate,  a  white  crystalline  precipitate, 
distinguishable  from  the  white  chlorid,  as  follows:  (i)  By 
its  crystalline  characters  (prisms  or  needles) ;  the  chlorid  is 
amorphous.  (2)  Its  sparing  solubility  in  ammonium  hy- 
droxid  ;  the  chlorid  is  very  soluble,  (3)  The  permanence 
of  its  color  when  exposed  to  the  light ;  the  chlorid  becomes 
dark-colored.  (4)  Its  solubility  in  boiling  nitric  acid ;  the 
chlorid  is  insoluble.  (5)  When  perfectly  dried,  and  heated 
in  a  small  reduction-tube,  the  silver  cyanid  is  decomposed, 
evolving  cyanogen  gas,  which  burns  with  a  characteristic 
rosy  flame.  (6)  By  adding  to  the  silver  cyanid,  hydro- 
chloric acid  and  ferric  sulphate,  Prussian  blue  will  be  formed. 

Another  mode  of  identifying  the  silver  cyanid,  recom- 
mended by  Orfila  and  Tardieu,  is,  after  thoroughly  washing 
and  drying  it,  to  introduce  it  into  a  small  glass  tube  closed 
at  one  end,  from  five  to  seven  inches  long,  and  containing 
in  its  closed  extremity  a  rather  less  quantity  of  pure  iodin. 
On  heating  this  end  of  the  tube  very  gently,  beautiful  snow- 
white  crystals  of  cyanogen  iodid  are  deposited  upon  the 
cool  portion  of  the  tube.  These  crystals  may  be  preserved 
indefinitely  in  sealed  tubes  ;  and  they  may  be  used  for  de- 
veloping Prussian  blue  by  dissolving  them  in  a  solution  of 
sodium  hydroxid,  and  adding  a  mixture  of  a  ferrous  and 
ferric  salt. 


HYDROCYANIC    ACID SILVER    TEST.  635 

The  silver  test  is  particularly  delicate  when  applied  to 
the  vapor.  For  this  purpose  the  material  containing  the 
suspected  poison  is  put  into  a  beaker  or  wide-mouthed 
flask,  and  a  watch-glass  containing  on  its  concave  surface  a 
drop  or  two  of  silver  nitrate  solution  is  inverted  over  the 
mouth  of  the  flask,  which  should  be  gently  heated  by  im- 
mersion in  warm  water.  The  vapor  immediately  arises,  and 
coming  in  contact  with  the  silver  salt,  forms  a  white,  opaque 
spot  of  silver  cyanid,  which  can  easily  be  recognized  by  a 
lens  and  by  the  other  tests  mentioned  above.  If,  however, 
the  material  should  be  in  a  state  of  putrefaction,  this  vapor- 
test  cannot  be  applied,  since  the  black  silver  sulphid  result- 
ing from  the  hydrogen  sulphid  would  completely  obscure 
the  white  cyanid. 

The  silver  vapor-test  is  considered  to  be  the  most  delicate 
of  all  the  tests.  It  is  stated  that  yo"oVi5o"  ^^  ^  grain  of  the 
acid  may  thus  be  distinctly  recognized.  Guy  mentions  that 
a  single  apple  pip,  bruised  and  moistened  with  water,  and 
placed  in  a  watch-glass,  over  which  was  inverted  another 
glass  moistened  with  the  silver  solution,  yielded  twenty-two 
distinct  reactions  —  each  spot  exhibiting,  by  the  microscope, 
crystals  of  silver  cyanid. 

2.  The  Iron  Test. — This  consists  in  adding  to  the  sus- 
pected solution  a  little  sodium  hydroxid  and  then  a  mixture 
of  ferrous  and  ferric  sulphates  ;  a  dirty  greenish-blue  pre- 
cipitate is  thrown  down,  which,  on  addition  of  a  few  drops 
of  pure  hydrochloric  acid,  becomes  Prussian  blue.  If  the 
amount  of  the  poison  be  very  minute  there  is  no  immediate 
precipitate,  although  the  solution  has  a  blue  (or  at  first, 
perhaps,  a  green)  color  ;  but  in  time  a  blue  precipitate  will 
subside. 

If  the  quantity  is  very  small,  it  is  recommended  to  throw 


636  TOXICOLOGY. 

the  liquid  upon  a  white  paper  filter  after  adding  the  hydro- 
chloric acid  ;  the  blue  deposit  on  the  paper,  after  washing 
with  very  dilute  acid,  will  show  very  distinctly  upon  the 
white  ground  ;  the  paper  when  dried  may  be  preserved  for 
exhibition,  if  needed. 

In  manipulating  with  this  test,  caution  should  be  used  not 
to  employ  an  excess  of  the  reagents,  as  this  materially  inter- 
feres with  the  success  of  the  experiment. 

The  iron  test  may  also  be  used  as  a  vapor-test.  Moisten 
the  watch-glass  with  a  drop  of  sodium  hydroxid  solution, 
and  after  exposure  to  the  suspected  vapors,  add  a  drop  or 
two  of  the  mixed  iron  salts  and  develop  the  Prussian  blue 
by  a  drop  of  dilute  hydrochloric  acid. 

3.  The  Sulphur  Test.  —  If  ammonium  sulphid  be  added 
to  a  solution  of  any  cyanid,  and  gently  heated  to  dryness, 
a  white  ammonium  thiocyanate  is  formed  ;  when  this  is 
touched  with  a  drop  of  ferric  chlorid  there  is  instantly  pro- 
duced the  blood-red  ferric  thiocyanate. 

The  sulphur  test  is  best  appHed  as  a  vapor-test.  Moisten 
a  watch-glass  with  a  drop  or  two  of  ammonium  sulphid  and 
invert  it  over  the  vessel  containing  the  substance  to  be 
tested,  gently  warming  the  latter  as  directed.  The  vapor 
will  rise  and  form  the  ammonium  thiocyanate  on  the  glass. 
When  this  is  allowed  to  dry  by  evaporation  it  appears  as  a 
white  spot,  and  when  it  is  touched  with  a  drop  of  the  ferric 
salt  it  immediately  assumes  the  characteristic  blood-red 
color.  If  the  evaporation  should  not  have  been  complete 
so  as  to  thoroughly  dry  it,  the  application  of  the  iron  salt 
may  produce  a  black  stain  (iron  sulphid),  which  will  obscure 
the  result. 

The  sulphur  test,  moreover,  may  be  applied  to  confirm 
the  silver  test.      For  this  purpose  the  spot  of  silver  cyanid 


HYDROCYANIC    ACID  — TOXICOLOGIC    EXAMINATION.     637 

should  be  moistened  with  a  drop  of  ammonium  sulphid,  and, 
when  thoroughly  diaed,  touched  with  a  drop  of  the  iron 
salt.  The  characteristic  blood- red  color  may  be  distin- 
guished in  spite  of  the  black  sulphid  with  which  it  is 
associated. 

4.  The  Copper  Test.  —  The  liquid  is  first  made  slightly 
alkaline  by  sodium  hydroxid  and  a  dilute  solution  of  copper 
sulphate  is  added  ;  a  greenish-white  precipitate  is  thrown 
down  which  becomes  nearly  white  on  the  addition  of  a  little 
hydrochloric  acid. 

This  test  may  be  used  also  as  a  vapor-test.  The  watch- 
glass  is  moistened  with  a  drop  of  the  copper  solution  made 
slightly  alkaline,  and,  after  exposure,  a  drop  of  dilute  hydro- 
chloric acid  is  added. 

As  regards  the  relative  delicacy  of  the  above  tests,  ex- 
periments show  that  for  the  liquid,  the  iron  and  sulphur 
tests  exceed  the  silver  test ;  but  when  in  the  form  of  vapor, 
the  latter  far  surpasses  all  the  others. 

Toxicologic  Examination. — The  stomach,  together  with 
its  contents,  and  other  viscera  (having  first  been  carefully 
examined  for  the  peculiar  odor)  should  be  distilled  in  a  glass 
retort,  at  a  moderate  temperature,  care  being  first  taken  to 
ascertain  if  the  material  is  acid  or  alkaline.  Unless  dis- 
tinctly alkaline,  no  acid  must  be  added,  otherwise  it  will  be 
impossible  to  determine  whether  the  hydrogen  cyanid  found 
in  the  distillate  was  originally  present  in  the  free  state,  or 
whether  it  might  not  have  resulted  from  the  action  of  the 
acid  used  upon  a  cyanid,  a  ferrocyanid,  or  a  thiocyanate 
that  might  have  been  present  in  the  material.  Of  course,  if 
potassium  cyanid  has  been  the  poison  employed,  the  con- 
tents of  the  stomach  would  give  an  alkaline  reaction,  in 
which  case  the  addition  of  sulphuric,  or  some  other  acid, 


638  TOXICOLOGY. 

would  be  perfectly  proper.     A  thiocyanate   exists  in   the 
saliva. 

In  the  case  of  Dr.  Paul  Schoeppe,  at  Carlisle,  Pa.,  in 
1868  and  1872,  this  point  was  brought  out.  The  allegation 
at  first  was  that  the  deceased  (a  woman  aged  fifty -four)  had 
been  poisoned  by  hydrogen  cyanid.  It  was  afterward  con- 
tended, on  the  failure  to  establish  this,  that  the  death  was 
due  to  a  mixture  of  that  and  morphin.  The  analyst 
employed  the  distillation  process,  along  with  sulphuric  acid, 
and  testified  to  his  having  only  obtained  faint  traces  of  a 
cyanid.  It  was  very  justly  contended  that  these  "traces" 
of  the  poison  could  readily  be  accounted  for  by  the  faulty 
process  employed  in  the  analysis ;  that  it  might  be,  in  fact, 
the  result  of  the  action  of  the  acid  upon  the  thiocyanate  of 
the  saliva.  Moreover,  there  was  an  entire  absence  of  the 
characteristic  symptoms  of  the  alleged  poison  before  death. 
At  the  second  trial,  the  evidence  of  the  prosecution  com- 
pletely broke  down,  and  the  prisoner  was  acquitted. 

The  source  of  the  poison  found  in  the  distillate,  when  an 
acid  is  employed,  may  be  determined  by  treating  a  portion 
of  the  original  material  with  a  few  drops  of  hydrochloric 
acid,  stirring  the  mixture  for  a  short  time,  and  adding  ferric 
chlorid.  If  the  liquid  contains  either  a  ferrocyanid  or  a 
thiocyanate,  the  former  will  be  indicated  by  the  formation 
of  Prussian  blue,  and  the  latter  by  the  red  ferric  thiocyanate  ; 
whereas,  a  cyanid,  such  as  potassium  cyanid,  will  not  give 
any  reaction  under  the  circumstances. 

As  regards  the  question  whether  prussic  acid  can  be 
generated  by  the  distillation  of  putrescent  animal  matters, 
although  Orfila  appears  to  have  inclined  to  this  belief,  it  is 
not  held  by  later  authorities.  Still,  something  more  should 
be  insisted  on  as  proof  of  poisoning  than  the  finding   of 


POTASSIUM    CYANID ANALYTIC    METHODS.  639 

"mere  traces,"  since  these  might  possibly  be  the  result  of 
some  animal  decomposition,  brought  about  under  condi- 
tions not  yet  perfectly  understood.  Especially  should  this 
be  insisted  on  when  the  symptoms  preceding  death  did  not 
agree  with  those  characteristics  of  the  alleged  poison. 

Period  after  Death  ivhen  the  Poison  may  be  found.  —  On 
account  of  its  volatility  and  ready  decomposition  all  traces 
of  the  poison  may  disappear  very  shortly  after  death.  Skill- 
ful analysts  have  failed  to  discover  it  in  twenty-six  hours 
after  death,  in  some  cases;  while  in  others  it  has  been  de- 
tected as  late  as  twenty-three  days  after. 

The  mere  fact  of  putrefaction  is  no  obstacle  to  its  detec- 
tion, although  in  such  a  case  it  will  not  be  discoverable 
either  by  distillation  or  by  the  vapor-tests.  It  may  have  all 
been  converted  into  ammonium  thiocyanate  by  the  am- 
monium sulphid  resulting  from  the  putrefaction.  In  such  a 
case  the  material  should  be  rendered  sHghtly  alkaline,  and 
then  acted  on  by  alcohol,  which  dissolves  the  thiocyanate  ; 
filter  and  evaporate  to  dryness  ;  dissolve  the  residue  in 
water,  and  test  by  a  ferric  salt. 

Potassium  Cyanid. — This  salt  is  employed  in  photog- 
raphy, electrotyping,  and  some  mining  operations,  and  is  a 
frequent  source  of  poisoning  to  artisans  engaged  in  these 
employments.  It  is  a  powerful  poison,  causing  death  in 
doses  under  five  grains. 

It  is  a  white  deliquescent  solid,  very  soluble  in  water, 
less  so  in  alcohol,  the  solution  giving  off  the  odor  of 
hydrogen  cyanid ;  it  has  an  alkaline  reaction. 

The  symptoms,  post-mortem  lesions  and  treatment,  are 
similar  to  those  described  under  hydrogen  cyanid. 

Analytic  Methods. — (i)  It  is  decomposed  by  acids,  hydro- 


640  TOXICOLOGY. 

gen  cyanid  being  liberated,  which  is  readily  recognized.  (2) 
It  gives  with  silver  nitrate  silver  cyanid.  (3)  The  potassium 
is  precipitated  by  tartaric  acid  and  platinum  chlorid.  (4) 
The  iron  and  copper  tests  may  be  used,  without  the  sodium 
hydroxid. 

Organic  mixtures  should  be  rendered  feebly  acid  with 
sulphuric  acid  and  distilled.  Hydrogen  cyanid  will  be  ob- 
tained in  the  distillate,  and  may  be  tested  as  indicated  above. 
The  caution  as  to  the  faint  reactions  due  to  cyanogen  com- 
pounds normally  present  or  not  poisonous  applies  here  also. 

Oil  of  Bitter  Almonds.  —  This  does  not  preexist  in  the 
bitter  almond,  but  results  from  the  reaction  of  water  upon 
its  amygdalin  and  synaptase.  It  is  obtained  by  distillation 
of  bitter  almonds  reduced  to  a  pulp  along  with  water.  It 
contains  a  variable  proportion  of  hydrogen  cyanid  and  ben- 
zaldehyd.  When  entirely  freed  from  the  former,  the  oil  is 
not  a  poison. 

Properties.  —  It  has  a  light  yellow  color,  pungent  odor, 
and  a  bitter,  aromatic  taste.  It  is  heavier  than  water,  in 
which  it  is  but  slightly  soluble ;  soluble  in  alcohol  and 
ether.  It  is  highly  poisonous.  The  liquid  sold  as  essence 
of  bitter  almonds  is  a  solution  of  this  oil  in  alcohol ;  it  is  a 
very  dangerous  substance  for  domestic  use. 

The  symptoms,  post-mortem  lesiojis  and  treatment,  are  the 
same  as  those  described  under  the  head  of  hydrocyanic 
acid.     The  fatal  dose  is  about  twenty  drops. 

Cherry-Laurel  Water,  obtained  by  distilling  a  macera- 
tion of  the  leaves  of  the  cherry-laurel  {Prmnis  Imirocerasiis), 
contains  a  portion  of  an  essential  oil  similar  to  the  oil  of 
bitter  almonds.     It   owes  its   poisonous  properties  to  the 


NITROBENZENE.  64! 

hydrogen  cyanid.  Cherry-laurel  water  has  occasionally 
proved  fatal.  It  is  especially  identified  with  the  case  of 
Donallen,  who  poisoned  his  brother-in-law,  Sir  Theodosius 
Broughton,  in  1782. 

The  seeds  of  the  peach,  apricot  and  cherry,  when  swal- 
lowed, have  proved  poisonous,  especially  to  children.  The 
symptoms  are  very  similar  to  those  produced  by  a  moderate 
dose  of  hydrogen  cyanid. 

Nitrobenzene,  or  Oil  of  Mirbane. — This  substance  is 
the  product  of  the  action  of  nitric  acid  on  benzene.  It  is  a 
pale  yellow  liquid,  with  a  strong  odor  of  bitter  almonds.  It 
is  used  in  perfumery  and  confectionery  as  a  cheap  substitute 
for  the  oil  of  bitter  almonds.  It  is  a  powerful  narcotic,  pro- 
ducing effects  resembling  those  of  hydrogen  cyanid,  although 
much  slower  in  its  operation,  requiring  four  or  five  hours 
before  death  occurs,  which  is  usually  preceded  by  coma,  as 
in  apoplexy.  This  poison  operates  more  rapidly  and  power- 
fully when  inhaled  in  the  form  of  vapor. 

In  a  fatal  case  it  may  generally  be  identified  by  its  strong 
odor. 

Analytic  Methods.  —  It  is  distinguished  from  the  oil  of 
bitter  almonds,  which  it  so  closely  resmbles  in  smell,  by 
pouring  a  few  drops  of  each  upon  a  plate  and  adding  a  drop 
of  strong  sulphuric  acid  ;  the  oil  of  bitter  almonds  acquires 
a  rich  crimson  color,  with  a  yellow  border,  while  the  nitro- 
benzene is  not  affected. 

It  gives  none  of  the  reactions  of  hydrogen  cyanid. 

When  associated  with  organic  substances,  as  the  stomach, 
etc.,  it  may  be  separated  by  first  adding  sulphuric  acid  and 
distilling. 

If  nitrobenzene  be  dissolved  in  alcohol  and  heated  with 
54 


642  TOXICOLOGY. 

hydrochloric  acid  and  granulated  zinc  for  some  time,  anilin 
will  be  formed.  If  the  solution  be  filtered  through  a  filter 
wetted  with  a  solution  of  sodium  hydroxid,  the  filtrate  nearly 
neutralized  with  the  same  substance,  and  a  dilute  solution  of 
chlorated  soda,  or  bleaching  powder,  be  added,  any  anilin 
present  will  produce  a  violet  color.  The  test  is  delicate,  but 
requires  careful  manipulation. 

Anilin,  which  is  a  derivative  of  nitrobenzene,  has  decid- 
edly poisonous  properties.  Persons  engaged  in  its  manu- 
facture or  use  are  subject  to  giddiness  and  headache,  and 
frequently  exhibit  a  cyanosed  condition  of  the  face  and  lips. 
Epileptiform  convulsions  and  insensibility  also  occur  in  the 
more  serious  cases.  Acute  poisoning  in  the  human  subject 
is  almost  unknown.  In  animals  the  principal  symptom  is 
loss  of  muscular  power  and  coordination.  There  is  no 
specific  antidote.  Anilin  can  be  recognized  by  the  produc- 
tion of  a  violet  color  with  chlorated  soda  solution,  as  noted 
under  nitrobenzene,  the  preliminary  treatment  with  hydro- 
chloric acid  and  zinc  being  omitted, 

Anilin  Colors,  under  which  term  are  also  included  numer- 
ous artificial  colors  made  from  coal-tar  derivatives  other  than 
anilin,  are,  as  far  as  known,  not  poisonous  in  the  ordinary 
sense  ;  that  is,  do  not  produce  distinct  symptoms  in  moderate 
doses.  Some  of  them  are  contaminated  with  poisonous 
accessory  or  by-products,  such  as  arsenic,  lead,  tin,  and 
copper.  Many  of  the  published  experiments  on  the  action 
of  anilin  colors  when  injected  into  the  bodies  of  animals  are 
without  value,  in  consequence  of  antiseptic  precautions  not 
being  observed. 

Synthetic  Coal-tar  Products.  —  Within  the  past  twenty 
years  many  substances  prepared  artificially  from   benzene^ 


SYNTHETIC    COAL-TAR    PRODUCTS,  643 

anilin  and  other  coal-tar  ingredients  have  been  introduced 
into  medical  practice,  largely  for  the  treatment  of  nervous 
affections,  especially  neuralgias.  The  so-called  "headache 
cures"  contain  generally  acetanihd  (often  called  antifebrin), 
caffein,  sodium  carbonate  or  ammonium  carbonate. 

Poisoning  by  these  agents  usually  exhibits  feeble,  slow- 
pulse,  subnormal  temperature,  cyanosis,  and  shallow  respi- 
ration, but  nausea  and  severe  vomiting  or  deep  insensibility 
are  sometimes  seen.  The  symptoms  are  probably  much  in- 
fluenced by  idiosyncrasy,  and  incidental  conditions  of  the 
system.  There  is  also  a  considerable  amount  of  substitu- 
tion, surreptitiously,  of  these  drugs,  so  that  unexpected 
effects  are  produced.  The  treatment  consists  in  washing 
out  the  stomach,  applying  warm  applications  externally  to 
restore  temperature  and  using  stimulants  such  as  alcohol, 
coffee  and  strychnin  internally.  The  following  notes  of  re- 
cently reported  cases  will  show  the  general  effects.  The 
first  is  a  case  of  poisoning  by  trional,  the  second  by 
acetanilid. 

1 .  In  this  case  the  patient  was  a  woman  aged  twenty-eight 
years.  There  were  well-marked  hallucinations  of  the  para- 
noic type.  The  symptoms  usually  seen  in  such  poisoning 
were  also  observed,  namely,  dizziness,  staggering,  loss  of 
the  reflexes,  deep  respiration  and  hematoporphyrinuria.  The 
last-named  symptom  appeared  late  in  the  case,  although  it 
is  usually  early.  The  patient  had  an  abnormally  small 
heart  and  her  previous  condition  was  such  as  to  lead  to 
considerable  loss  of  weight,  which  may  have  caused  special 
susceptibility  to  the  poison.  The  patient  succumbed  to  the 
poison,  and  the  post-mortem  showed  no  lesions  that  could 
account  for  the  death. 

2.  The    patient,   a   man,   took    60   grains   of  acetanilid 


644  TOXICOLOGY. 

within  a  few  hours  for  headache.  He  became  delirious, 
feverish,  somewhat  jaundiced  and  complained  of  headache 
and  pain  in  the  umbilical  region.  There  was  hyperesthesia 
with  increased  reflexes,  persistent  vomiting,  so  that  nourish- 
ment could  only  be  carried  on  by  the  rectum  ;  weak  pulse, 
shallow  respiration,  subnormal  temperature  and  continuous 
falling  off  in  the  number  of  red  blood  cells  with  leukocytosis. 
The  urine  contained  hematoporphyrin  but  in  the  latter  stage 
of  the  case  complete  suppression  occurred.  He  died  on  the 
eighth  day,  the  final  condition  being  acute  nephritis,  intestinal 
hemorrhage  and  jaundice. 

DIGITALIS. 

The  purple  Foxglove  {Digitalis  purpurea)  is  a  native  of 
Europe,  but  cultivated  in  our  gardens.  All  parts  of  the 
plant  contain  several  active  principles,  of  which  the  most 
important  are  digitalin,  digitoxin,  digitonin,  and  digitalein. 
These  are  glucosids,  not  alkaloids. 

The  chief  poisonous  principles  are  digitalin  and  digitoxin, 
which  always  accompany  each  other  in  the  plant. 

Symptoms.  —  Cases  of  digitalis  poisoning  are  compara- 
tively rare.  Until  recently,  its  action  was  generally  re- 
garded as  a  direct  cardiac  depressant,  reducing  both  the 
force  and  frequency  of  the  heart's  action.  Therapeutists 
are  now  disposed  to  consider  it  as  a  direct  heart  stimulant, 
asserting  that  while  the  pulsations  of  the  heart  are  dimin- 
ished in  frequency  they  are  increased  in  power. 

The  poisonous  impressions  on  man  are  nausea  and  vom- 
iting, purging,  with  severe  abdominal  pains,  a  sense  of  heat 
in  the  head,  vertigo,  disordered  vision,  and  dilated  pupils  ; 
the  pulse  full  and  slow  in  the  horizontal  position,  but  rapid 
and  feeble  on  sitting  up.     Prostration  then  comes  on,  with 


DIGITALIN.  645 

a  tendency  to  syncope  ;  the  eyes  very  prominent  and  fixed, 
the  sclerotic  coat  acquiring,  according  to  Tardieu,  a  pecu- 
liar, characteristic  blue  color.  Sometimes  there  is  saliva- 
tion and  suppression  of  urine  ;  delirium,  stupor,  and  con- 
vulsions are  apt  to  come  on  just  before  death,  which  does 
not,  as  a  rule,  occur  within  twenty-four  hours.  Tardieu 
mentions  a  case  in  which  death  took  place  in  three  quar- 
ters of  an  hour  after  swallowing,  by  mistake,  a  very  large 
dose. 

Digitalis  seems  to  have  a  tendency  to  break  out  with 
violence  after  taking  a  number  of  moderate  doses.  The 
diagnostic  sign  of  the  action  of  digitalis  is  the  peculiar 
enfeebled,  intermittent  pulse,  which  varies  so  notably  be- 
tween the  supine  and  the  erect  position  of  the  patient. 

Post-mortem  Appearances.  —  Nothing  very  characteristic  is 
observed.  Turgescence  of  the  vessels  at  the  base  of  the 
brain,  together  with  redness  of  the  lining  membrane  of  the 
stomach,  has  been  noted. 

Fatal  Dose. — This  is  not  accurately  settled.  As  much 
as  a  drachm  of  the  powder,  and  half  a  fluidounce  of  the 
tincture  have  been  taken  with  impunity  ;  but  a  far  less 
quantity  has  produced  decided  effects  on  the  heart's  action. 
The  usual  dose  is  one  to  two  grains  of  the  powder,  and  ten 
drops  of  the  tincture,  to  be  repeated. 

Digitalin.  —  This  generally  occurs  as  an  amorphous  pow- 
der of  a  pale  yellowish  color ;  but  when  pure,  in  fine  white 
crystals.  There  seems  to  be  much  diversity  of  opinion  con- 
cerning the  percentage  of  digitalin  in  the  leaves,  some  au- 
thorities giving  it  at  about  ten  per  cent.,  whilst  Blaquart 
asserts  that  there  are  ten  to  twelve  per  cent,  of  the  crystal- 
lizable  variety. 


646  TOXICOLOGY. 

There  seems  to  be  a  true  antagonism  between  digitalin 
and  aconitin.  It  is  stated  that  when  the  heart  of  the  frog 
has  almost  ceased  to  beat  under  the  influence  of  digitalin, 
its  movements  are  restored  by  aconitin ;  and  a  case  is 
reported  of  recovery  after  the  ingestion  of  an  ounce  of 
Fleming's  tincture  of  aconite,  apparently  due  to  the  hypo- 
dermic injection  of  twenty  minims  of  tincture  of  digitalis, 
and  the  exhibition  by  the  mouth  of  three  doses  of  one 
drachm  each,  within  an  hour,  together  with  brandy  and 
ammonium  hydroxid. 

Analytic  Methods. — Both  the  amorphous  and  crystalline 
varieties  have  a  very  bitter  taste  ;  very  sparingly  soluble  in 
water,  also  in  pure  ether,  but  very  soluble  in  ether  contain- 
ing alcohol.  Chloroform  is  its  best  solvent.  It  has  no 
alkaline  reaction.  Cold  sulphuric  add  imparts  to  it  a  brown- 
ish color,  which  gradually  changes  to  a  red.  If  warmed, 
the  color  passes  to  a  brown.  If  to  the  cold  brown  solution 
an  excess  of  water  be  added,  the  color  changes  to  a  green, 
depositing  a  green  powder,  and  the  liquid  gradually  assumes 
a  yellowish  tint  (Tardieu).  Strong  nitric  acid  dissolves  it 
with  effervescence,  giving  off  red  fumes,  and  imparting  an 
orange-red  color,  which  gradually  becomes  fainter.  Hydro- 
chloric acid  imparts  to  it  a  light  greenish  tint.  It  is  stated 
that  if  the  brown  sulphuric  acid  solution  be  exposed  to 
bromin  vapor  it  assumes  a  violet  hue,  but  Tardieu  denies 
that  this  test  is  at  all  characteristic. 

Toxicologic  Examijtation.  —  In  a  suspected  case  the  ex- 
aminer should  first  carefully  search  for  fragments  of  the 
powdered  leaves  in  the  matters  vomited  and  in  the  alimen- 
tary canal.  If  the  tincture  has  been  swallowed,  the  interior 
of  the  stomach  might  present  a  greenish  color  and  emit  a 
suggestive  odor.     If  digitalin  granules  have  been  taken,  a 


DIGITALIN TOXICOLOGIC    EXAMINATION.  64/ 

careful  post-mortem  inspection  might  possibly  reveal  the 
presence  of  some  of  them  remaining  in  the  stomach. 

The  viscera,  properly  comminuted,  should  first  be  heated 
on  a  water-bath  with  strong  alcohol  for  a  considerable  time. 
After  cooling  and  straining  and  proper  concentration  by 
evaporation,  part  of  the  extract  may  be  used  as  a  trial  test 
on  a  small  animal.  The  rest  of  it  should  be  further  puri- 
fied by  another  solution  in  alcohol,  filtration  and  evapora- 
tion, and  the  physiologic  test  again  repeated. 

It  is  impossible  to  determine  positively  the  existence  of 
the  poison  by  any  chemical  tests,  nor  by  the  post-mortem 
lesions ;  our  reliance  must  be  solely  on  the  physiologic 
test  —  injecting  hypodermically  some  of  the  ultimate  extract 
into  a  small  animal,  as  the  frog.  It  seems  well  established 
by  numerous  experiments  that  death  takes  place  by  a  sud- 
den cessation  of  the  heart's  action,  with  a  decided  rigidity 
of  the  ventricles  at  the  moment  of  death.  In  frogs  this 
stoppage  occurs  always  in  the  state  of  strong  systole  of  the 
ventricle. 

By  observing,  then,  the  action  of  the  suspected  poison 
introduced  under  the  skin  of  the  frog,  the  gradual  irregu- 
larity and  slowness  of  the  heart-beats,  together  with  the 
manner  of  its  final  stop,  and  experimenting  at  the  same 
time  with  digitalin  itself  upon  another  animal,  we  may  be 
able  to  arrive  at  a  satisfactory  conclusion. 

The  most  noted,  if  not  the  only  instance,  of  homicidal 
poisoning  by  digitalin  is  that  of  de  la  Pomerais,  a  homeo- 
pathic practitioner  of  France,  who  was  tried  and  convicted 
for  killing  his  mistress  after  having  insured  her  life  in  vari- 
ous ofifices  for  his  own  benefit.  After  one  of  his  visits 
to  her  she  died,  after  suffering  from  violent  vomiting  and 
great  depression  of  the  heart's  action  and  debility,  in  twenty- 


648  TOXICOLOGY. 

four  hours.  Her  body  was  examined  thirteen  days  after 
death,  suspicion  having  been  aroused  against  the  prisoner. 
The  examiners,  Tardieu  and  Roussin,  faihng  to  discover 
any  poison  by  chemical  research,  resorted  to  the  above- 
mentioned  physiologic  test,  employing  the  extract  obtained 
from  the  stomach  and  bowels  and  also  one  procured  from 
the  scrapings  of  the  floor  on  which  the  deceased  had  vom- 
ited, both  of  which  responded  likewise  to  all  the  known 
chemical  reactions.  A  strong  circumstantial  evidence  of 
the  guilt  of  the  accused  was  the  finding  in  his  possession 
of  an  unusually  large  amount  of  digitalin,  a  substance  that 
had  only  lately  been  discovered,  besides  a  number  of  other 
deadly  poisons.     He  was  condemned  and  executed. 

Poisoning  by  Cocculus  Indicus.  —  Cocculus  Indicus  {Le- 
vant nut)  is  the  fruit  of  the  Menispermum  cocculus,  a  tree 
growing  in  the  East  Indies.  The  kernel  of  the  berry  is  the 
only  poisonous  part.  It  has  an  intensely  bitter  taste,  and 
contains  a  highly  poisonous  principle  called  picrotoxin.  It 
is  chiefly  employed  as  a  fish  poison  and  sometimes  for  the 
malicious  destruction  of  game.  It  is  popularly  believed  to 
be  used  for  adulterating  malt  liquors,  by  imparting  to  them 
a  bitter  flavor  and  increased  intoxicating  powers,  but  this 
must  be  unusual.  It  is  also  used  for  the  destruction  of 
vermin. 

The  symptoms  are  somewhat  singular,  indicating  an 
action  on  the  cerebro-spinal  centers.  There  is  loss  of  vol- 
untary power,  but  not  of  consciousness,  the  sufferer  lying 
in  a  sort  of  nightmare.  There  may  also  be  nausea,  vomit- 
ing and  severe  abdominal  pains.  Dr.  Fish  reported  cases 
of  accidental  poisoning  of  six  persons  in  the  Philadelphia 
Hospital  by  a  decoction  of  this  substance.     Two  of  these 


POISONING    BY   COCCULUS    INDICUS.  649 

died  in  about  half  an  hour  ;  the  remaining  four  were  seized 
with  violent  symptoms  within  half  an  hour  after  swallowing 
the  poison,  and  recovered  after  several  hours.  Their  symp- 
toms were  faintness,  confusion  of  mind,  giddiness,  dimness 
of  vision,  nausea,  excessive  thirst,  severe  abdominal  pain, 
and,  in  one  case,  insensibility ;  the  pulse  was  much  weak- 
ened and  the  respiration  slow  and  labored. 

The  external  application  has  been  followed  by  violent 
and  even  fatal  effects. 

Picrotoxin  constitutes  about  one  per  cent,  of  the  kernel. 
It  crystallizes  in  colorless,  silken,  slender,  four-sided  prisms  ; 
sparingly  soluble  in  water,  very  soluble  in  alcohol,  ether, 
chloroform,  and  amylic  alcohol.  Cold  sulphuric  acid  does 
not  affect  it ;  the  hot  acid  imparts  to  it  an  orange-yellow 
color,  which  becomes  pale  on  cooling.  Strong  nitric  acid 
and  hydrochloric  acid  do  not  affect  it.  It  acts  like  grape 
sugar  when  boiled  with  copper  sulphate  and  sodium  hy- 
droxid. 

It  may  be  separated  from  organic  liquids  by  first  acidu- 
lating with  hydrochloric  acid  and  then  shaking  up  with 
ether,  which  holds  the  poison  in  solution  and  deposits  it  in 
crystals. 

There  are  several  other  vegetable  poisons  of  minor  im- 
portance ;  among  them  may  be  mentioned  the  bark  and 
seeds  of  the  Laburnum  {Cytisus  laburnuni),  a  very  common 
tree  or  shrub  of  Great  Britain.  It  contains  an  active  poi- 
sonous alkaline  principle,  cytisin,  whose  effects  are  those  of 
an  irritant  narcotic.  Death  has  frequently  resulted  from 
swallowing  both  the  bark  and  seeds  of  this  plant. 

The  leaves  and  berries  of  the  Yew  {Taxus  baccatd)  act 
powerfully  as  an  acrid,  irritant  narcotic,  even  in  small  quan- 
tities.    They  owe  their  poisonous  properties  to  an  alkaloidal 


650  TOXICOLOGY. 

principle  which  destroys  life  by  paralyzing  the  respiratory 
center. 

The  Privet  {Ligustruin  vulgare),  the  Guelder  Rose  {Vi- 
burnuin  opiihis),  and  the  Holly  {Ilex  aqidfoliuni)  also  pos- 
sess poisonous  properties. 

PTOMAINS. 

Within  the  past  few  years  the  attention  of  toxicologists 
has  been  called  to  the  existence  of  a  certain  class  of  bodies, 
to  which  Selmi  gave  the  name  of  Ptomains  (from  nzwixa,  a 
dead  body),  resulting  from  the  decay  of  organic  substances. 
These  bodies  strongly  resemble  the  alkaloids  in  their  chemic 
and  physiologic  actions.  Whilst  some  of  them  are  very 
poisonous  the  majority  are  inert,  and  others  again  seem  to 
be  antagonistic  to  certain  poisons. 

It  has  long  been  known  that  putrescent  meat  will  occa- 
sion severe  and  sometimes  fatal  symptoms  in  persons  who 
partake  of  it.  These  symptoms  are  of  a  narcoto-irritant 
character  and  strongly  resemble  those  produced  by  certain 
familiar  poisons.  Similar  effects  are  also  known  to  occa- 
sionally result  from  cheese,  sausages,  and  certain  shell-fish, 
particularly  from  mussels,  and,  in  some  instances,  from 
canned  meat  and  vegetables.  These  anomalous  symptoms 
have  formerly  been  attributed  to  various  causes,  but  hitherto 
no  satisfactory  explanation  of  them  has  ever  been  offered 
until  the  discovery  of  the  ptomains  has  solved  the  mystery 
and  afforded  a  rational  and  scientific  solution. 

It  is  now  known  that  putrefaction  is  due  to  the  presence 
of  microbes,  which,  when  introduced  into  the  animal  body, 
may  speedily  develop  serious  and  even  fatal  disease.  This 
fact  affords  a  satisfactory  explanation  of  those  otherwise 
obscure  cases  of  poisoning  that   occasionally  result  from 


PTOMAINS.  651 

partaking  of  certain  articles  of  food,  such  as  canned  provi- 
sions, milk,  ice-cream,  sausage,  cheese,  etc.,  which  have 
undergone  unsuspected  putrefaction. 

Many  ptomains  have  been  isolated,  and  the  discovery  has 
opened  a  new  field  of  investigation  in  physiologic  chemistry. 
Some  ptomains  bear  a  strong  resemblance  to  some  of  the 
vegetable  alkaloids  in  both  chemical  and  physiologic  reac- 
tions ;  and  as  they  may  generate  by  putrefaction  in  the 
human  viscera,  it  may  readily  happen  to  the  analyst  to 
encounter  one  of  these  ptomains  in  searching  for  strychnin, 
morphin,  nicotin,  etc.,  in  a  putrescent  human  body.  For- 
tunately the  ptomains  occurring  under  the  above  conditions 
are  not  always  met  with  ;  moreover,  the  expert,  with  proper 
precaution,  will  be  able  to  discriminate  between  them  and 
the  true  alkaloids  from  the  fact  that,  although  they  have 
many  points  in  common,  there  exist  reactions,  both  chemic 
and  physiologic,  in  which  they  differ. 

Another  point  in  this  connection  that  should  not  be  over- 
looked by  the  toxicologist  is  the  fact  that  the  presence  of 
one  or  more  of  these  ptomains,  along  with  certain  of  the 
vegetable  alkaloids,  in  a  dead  body  may  interfere  with  the 
usual  chemical  tests  employed  for  the  detection  of  the  latter 
poison.  This  is  true,  to  some  extent,  in  the  case  of  strych- 
nin, brucin,  atropin,  aconitin,  picrotoxin,  and  a  few  others ; 
but  this  subject  has  not  received  sufficiently  full  attention  to 
enable  us  to  speak  very  positively  about  it.  Ranke  contends 
that  the  proper  physiologic  action  of  the  impure  strychnin 
extracted  from  a  putrefied  body  may  be  masked  by  ptomains. 
If  this  observation,  as  also  those  above  mentioned,  is  correct, 
it  may  explain  the  occasional  failure  to  discover  strychnin 
and  other  alkaloids  in  a  putrescent  body. 

Selmi  and  others  have  succeeded  in  extracting  poisonous 


652  TOXICOLOGY. 

bases  from  the  urine  of  patients  suffering  from  tetanus,  pro- 
gressive paralysis,  and  miliary  fever  ;  one  of  these  resembled 
nicotin  in  its  general  character,  showing  a  special  tendency 
to  act  upon  the  spinal  marrow  and  heart ;  the  other  base 
resembled  conin  in  odor. 

Still  later  researches  go  to  prove  that  animal  fluids,  such 
as  fresh  blood  and  albumin,  before  undergoing  putrefaction, 
give  precisely  similar  reactions,  with  the  reagents  employed, 
to  those  that  are  afforded  by  these  same  reagents  with 
ptomains  extracted  from  a  dead  animal  body. 

It  will  be  inferred  from  all  that  has  been  stated  upon  this 
subject  that  the  whole  matter  concerning  ptomains  may  be 
regarded  as  being,  to  a  considerable  extent,  still  sub  judice  ; 
and  the  existence  of  these  cadaveric  alkaloids  in  human  vis- 
cera, even  \yhen  putrid,  is  probably  not  of  such  frequent 
occurrence  as  was  suspected.  Nevertheless,  it  cannot  be 
doubted  that  their  alleged  existence  will  be  constantly 
brought  out  in  trials.  Such  a  course  is  stated  to  have  been 
taken  at  the  Lamson  trial,  in  London,  in  1883.  On  the 
other  hand,  it  might  be  speciously  argued  that  the  reason 
for  the  non-discovery  of  the  alleged  alkaloid  was  to  be 
attributed  to  the  interfering  presence  of  some  ptomain. 

Much  light  has  been  thrown  upon  the  relations  of  the 
ptomains  in  toxicologic  chemistry  by  the  investigations 
ofVaughan.  Ordinary  putrefactions  are  aerobic — that  is, 
take  place  under  the  influence  of  free  oxygen.  Laboratory 
studies  of  decompositions,  either  in  culture  fluids  or  in 
ordinary  foods,  have  been,  therefore,  largely  limited  to  one 
class  of  actions — those  of  microbes  which  grow  in  the 
presence  of  oxygen.  It  is  now  known,  however,  that  not 
only  are  there  several  species  of  microbes  which  grow  only 
in  the  absence  of  oxygen,  but  some  of  those  ordinarily  grow- 


PTOMAINS.  653 

ing  in  contact  with  oxygen  can  grow  in  its  absence,  pro- 
ducing substances  different  from  those  formed  under  normal 
growth.  In  buried  corpses  the  decompositions  will  be  at 
low  temperatures,  and  with  at  least  very  deficient  oxygen 
supply;  hence  the  transformations  occurring  in  the  viscera 
will  not  be  identical  with  those  when  the  body  lies  unburied 
or  submerged  in  water,  Vaughan  has  shown  that  it  is  in 
this  anaerobic  decomposition  that  ptomains  simulating  the 
vegetable  poisons  are  likely  to  be  formed.  In  a  recent 
trial  it  was  claimed  by  Vaughan  and  others  that  an  organic 
product  of  animal  putrefaction,  commonly  called  indol  (but 
properly  indin),  gives  color-reactions  simulating  some  of 
those  of  morphin.  It  seems,  however,  that  the  probability 
of  error  from  this  cause  has  been  overrated,  and  in  general 
it  may  be  said  that,  with  careful  routine  work,  there  is  no 
great  danger  of  ptomains  being  mistaken  for  the  well-known 
alkaloid  poisons.  Much  more  extended  investigation  will 
be  needed  to  give  precision  in  this  field. 


55 


INDbX 


ABDOMEN,  wounds  of,  130 
Abortion,  criminal,  220 
feigned,  233 
means  employed,  230 
proofs  of,  221 
Abortives,  230 
Abstinence  from  food,  194 
Acetanilid,  643 
Acetate  of  lead,  499 
Acid,  acetic,  527 

arsenic,  472 

arsenous,  449 

carbolic,  528 

hydrochloric,  423 

hydrocyanic,  630 

meconic,  561 

nitric,  419 

oxalic,  521 

sulphuric,  416 

tartaric,  527 
Aconite,  poisoning  by,  624 
Aconitin,  625 
Aconitum  napellus,  623 
Adipocere,  54 
Age  deduced  from  teeth,  89 

of  fetus,  226 

of  new-born  children,  229 

of  skeletons,  90 
Alcohol,  poisoning  by,  565 

methyl,  poisoning  by,  570 
Alkalies,  poisoning  by,  426 
Alum,  poisoning  by,  433 
Ammonia,  poisoning  by,  426 
Anesthesia  in  rape,  301 
Anesthetics,  572 
Anilin,  642 

colors,  642 
Animal  food,  noxious,  548 

irritants,  548 
Antagonism  of  poisons,  393 
Antifebrin,  643 
Antimony,  poisoning  by,  474 


Antipyrin,  642 

Apparent  death,  33 

Aqua-fortis,  419 

Arsenic,  449 

Arsenite  of  copper,  473 

Arseniuretted  hydrogen,  474 

Artificial  inflation  of  lungs,  243 

Asphyxia,  1 54 

Atropa  belladonna,  602 

Atropin,  603 

BALLOTTEMENT  in  pregnancy, 
215 
Balls,  apertures  made  by,  119 
Barium,  salts  of,  434 
Bean,  calabar,  628 
Belladonna,  poisoning  by,  602 
Betanaphthol,  533 
Bettendorf  s  test,  466 
Bichlorid  of  mercury,  485 
Binoxalate  of  potassium,  527 
Birth,  premature,  220 

proofs  of  a  live,  237 
Bismuth,  poisoning  by,  518 
Bitter  almonds,  oil  of,  640 
Bittersweet,  poisoning  by,  610 
Black  drop,  555 

hellebore,  541 
Blisters  from  burns  and  scalds,  150 
Blood  corpuscles,  comparative  study 
of,  144 

crystals,  1 37 

action  of  poisons  on,  400 

stains,  detection  of,  131 
Blue  vitriol,  5 10 
Body,  pallor  of,  36 
Bones,  age  of,  90 

human  and  animal,  87 

identification  of,  87 
Borax,  527 
Boric  acid,  527 
Born  alive,  meaning  of,  235 


655 


656 


INDEX. 


Brain,  injuries  of,  126 

Breasts,    changes   of,   in   pregnancy, 

213 
Bromin,  446 

Brucin,  poisoning  by,  600 
Buoyancy  of  the  body,  182 
Burns  and  scalds,  death  from,  148 

CADAVERIC  alkaloids,  652 
lividity,  43 
rigidity,  38 
spasm,  42 
Calabar  bean,  628 
Caloricity,  post-mortem,  36 
Camphor,  547 

Cantharides,  poisoning  by,  548 
Cantharidin,  548 
Capacity,  testamentary,  351 
Carbolic  acid,  poisoning  by,  528 
Carbon  monoxid,  159 
Castor  beans,  536 
Certificates  of  insanity,  350 
Cheese,  poisoning  by,  550 
Cherry-laurel  water,  640 
Chest,  wounds  of,  1 29 
Chloral  hydrate,  576 
Chlorin,  448 

oxids,  448 
Chloroform,  poisoning  by,  573 
Chromate  of  lead,  505 
Chrome  yellow,  505 
Chromium,  poisoning  by,  520 
Cicatrices,  identification  by,  82 
Clothing,  examination  of,  ill 

stabs  in.  III 

stains  of,  62 
Cocain,  612 
Cocculus  indicus,  648 
Colchicum,  poisoning  by,  537 
Cold,  death  from,  190 
Coldness  of  the  body  in  death,  36 
Colic,  painters',  500 
Colica  pictonum,  50x3 
Colostrum,  251,  270 
Coma,  death  by,  29 
Combustion,  spontaneous,  153 
Compression  of  brain,  126 
Concealment  of  birth,  271 

of  delivery,  271 

of  habits  in  life  insurance,  379 

of  pregnancy,  21 1 
Conception,  date  of,  275 


Concussion  of  brain,  125 

of  spinal  marrow,  1 28 
Confessions  in  drunkenness,  330 
Conin,  621 

Conium  maculatum,  620 
Contusions  on  the  living  and  the  dead, 

106 
Convallaria  majalis,  poisoning  by,  547 
Cooling  of  the  body  after  death,  36 
Copper,  poisoning  by,  506 
Copperas,  poisoning  by,  520 
Cord,  mark  of,  in  hanging,  169 

in  strangulation,  165 
Coroner,  18 
Coroner's  inquests,  1 8 
Corpqs  luteum,  216 

sublimate,  484 
Courtesy,  tenancy  by,  281 
Cranium,  fractures  of,  127 
Cretinism,  324 
Criminal  abortion,  220 

court,  20 

responsibility,  355 
Croton  oil,  poisoning  by,  535 

tiglium,  535 
Crying,  evidence  from,  281 
Crypsorchides,  290 
Cyanid  of  potassium,  639 
Cytisin,  649 
Cytisus  laburnum,  649 

DATE  of  conception,  275 
Datura  stramonium,  608 
Daturin,  608 
Dead  body,  examination  of,  60 

wounds  and  contusions,  104 
Deadly  nightshade,  602 
Death,  phenomena  and  signs  of,  28 

presumption  of,  72 

violent,  causes  of,  10 1 
Deformities,  evidence  from,  95 
Delirium  tremens,  33 1 
Delivery,  concealed,  271 

feigned,  272 

signs  of,  271 

unconscious,  271 
Delusions,  318 
Dementia,  339 
Diffusion  of  poisons,  387 
Digitalin,  644 
Digitalis,  poisoning  by,  644 
Dipsomania,  330 


INDEX. 


657 


Divorce,  legal  grounds  for,  292 
Doubtful  sex,  288 
Douglass  peerage  case,  285 
Drowned,  restoration  of  the,  184 
Drowning,  death  from,  174 

signs  of,  177 
Drunkenness,  responsibility  of,  330 
Dying  declarations,  26 

ECBOLICS,  230 
Elaterium,  536 
Electricity,  death  from,  185 
Emerald  green,  poisoning  by,  473 
Emetic,  tartar,  474 
Epilepsy,  342 

feigned,  203 
Epsom  salt,  517 
Ergot,  230 
Eserin,  628 

Essence  of  mirbane,  641 
Essential  oil  of  almonds,  640 
Ether,  poisoning  by,  572 
Eucain,  613 

FACE,  wounds  of,  128 
Farina  in  stomach  of  new-born 
child,  252 
Fasting,  continued,  194 
Features,  evidence  from,  285 
Fecundation,  275 
Feigned  abortion,  233 

delivery,  272 

diseases,  197 

insanity,  359 
Fetal  circulation,  247 

vessels,     changes    in,     at   birth, 
247 
Feticide,  220 
Fetus,  character  of,  226 
Food,  poisonous,  549 
Formaldehyde,  571 
Fowler's  solution,  472 
Foxglove,  poisoning  by,  644 
Fractures,  identity  from,  95 

in  new-born  children,  257 
Fungi,  poisonous,  542 

r^  ALL-BLADDER,     wounds    of. 


KJ 


130 


Gardner  peerage  case,  277 
Gelsemic  acid,  544 
Gelsemin,  544 


Gelsemium  sempervirens,  543 
Gestation,  legal  decisions,  275 

normal  period,  279 

premature,  279 

protracted,  279 
Gonorrhea  in  rape,  295 
Green  hellebore,  541 
Guaiacum  test  for  blood,  134 
Gunpowder,  wounds  from,  121 
Gunshot  wounds,  1 18 

HABITS,  concealed,  379 
Hair,  identification  of,  97 
dyes,  99 
Hallucinations,  317 
Hanging,  death  by,  168 
Head,  wounds  of,  125 
Heart,  wounds  of,  129 
Heat  a  cause  of  death,  189 
Hellebore,  poisoning  by,  541 
Hemin  crystals,  137 
Hemlock,  poisoning  by,  620 
Hemoglobin,  132 
Henbane,  poisoning  by,  609 
Hermaphroditism,  288 
Holly,  650 

Homicidal  mania,  331 
Human  bones,  87 
Hydatids,  uterine,  221 
Hydrate  of  chloral,  576 
Hydrochloric  acid,  423 
Hydrocyanic  acid,  630 
Hydrogen  cyanid,  630 
Hydrostatic  test,  241 
Hymen,  evidence  from,  306,  310 
Hyoscyamin,  609 
Hyoscyamus,  poisoning  by,  609 

IDENTITY  of  the  dead,  85 
*      of  the  living,  79 

personal,  78 
Idiocy,  323 
Illusions,  316 
Imbecility,  325 
Impotence,  289 

Impregnation,  unconscious,  218 
Incised  wounds,  I09 
Indian  tobacco,  619 
Infanticide,  234 

proofs  of  live  birth  in,  236 
Infantile  leucorrhea,  299 
Inflation  of  lungs,  243 


658 


iNDEJi. 


Inheritance,  274 

Inquests,  coroner's,  18 
Insanity,  314 

feigned,  314 

medico-legal  questions  in,  315 

post-mortem  signs  of,  345 
Insurance,  life,  376 
Intellectual  insanity,  327 
Intemperance   in  relation  to  life  in- 
surance, 377 
Interments,  premature,  32 
Intestines,  wounds  of,  130 
Intoxication  distinguished  from  con- 
cussion, 126 
lodin,  poisoning  by,  445 
Iron,  salts  of,  520 

rust  on  weapons,  131 

1 ASMINE,  yellow,  543 
^  Juniperus  sabina,  532 
Jury,  coroner's,  19 

grand  and  petty,  20 

of  matrons,  210 

I^LEPTOMANIA,  329 

LABOR,  premature,  220 
Laburnum,  649 
Laudanum,  555 
Lead,  poisoning  by,  497 
Legitimacy,  274 

laws  concerning,  283 
Leucorrhea,  infantile,  299 
Levant  nut,  648 
Life  insurance,  376 
Lightning,  death  from,  185 
Lily   of    the    Valley,    poisoning    by, 

.547 
Linea  albicantes,  270 
Linen,    microscopic    appearance    of, 

100 
Live  birth,  235,  280 
Lividity,  cadaveric,  43 
Lobelia  inflata,  619 
Lobelin,  619 
Lochia,  270 
Locomotion  after  injuries  of  the  head, 

112 
Lucid  intervals,  322 
Lungs,  examination  of,  in  new-bom 

children,  239 
Lysol,  531 


MAGNESIUM  sulphate,  517 
Majority  and  minority,  284 
Malpractice,  medical,  365 
Mania,  325 

feigned,  359 

homicidal,  331 

moral,  328 

suicidal,  333 
Marsh's  test,  460 
Maternity,  early,  217 
Matrons,  jury  of,  210 
Meat,  poisoned,  549 
Meconic  acid,  561 
Meconium,  251 
Melancholia,  326 
Membrana  pupillaris,  227 
Menstrual  blood,  211 
Menstruation,  211 
Mercury,  poisoning  by,  484 
Methyl  alcohol,  570 

bromid,  578 
Microscopy  in  blood  stains,  138 
Milk,  detection  of,  in  stomach,  251 
Mineral  acids,  poisoning  by,  414 
Mirbane,  essence  of,  641 
Miscarriage,  220 
Moles  in  pregnancy,  222 
Monkshood,  poisoning  by,  623 
Monomania,  327 

homicidal,  331 

suicidal,  333 
Monsters,  282 
Moral  insanity,  328 
Morning  sickness,  21 1 
Morphin,  559 
Muriatic  acid,  423 
Muscular  irritability  after  death,  39 
Mushrooms,  poisonous,  545 
Mussels,  poisonous,  549 
Mutilated   bodies,    identification     of, 
85 

NAPHTHALENE,  534 
Naphthol,  533 
Narcotics,  554 
Neurotic  poisons,  554 
Nevi,  identification  by,  82 
Nicotin,  615 
Niter,  death  from,  431 
Nitric  acid,  419 

Nitrobenzene,  641  . 

Nux  vomica,  poisoning  by,  578 


INDEX. 


659 


OIL  of  bitter  almonds,  640 
of  mirbane,  641 

of  savin,  532 

of  vitriol,  416 
Oleander  poisoning,  540 
Opium,  poisoning  by,  554 
Ordeal  bean,  628 
Orpiment,  474 

Osmosis  of  poisons  after  death,  402 
Oxalic  acid,  519 

pAINTERS'  colic,  500 
'  Palsy  from  lead,  500 
Paralysis,  feigned,  205 

of  insane,  337 
Parental  likeness,  285 
Paternity,  285 
Pederastia,  311 

Perforation  of  stomach,  401,  416 
Personal  identity,  78 
Phenol,  527 

Phosphorus,  poisoning  by,  435 
Physostigmin,  628 
Picrotoxin,  648 
Poisonous  food,  549 
Poisons,  absorption  of,  387 
antagonism  of,  393 
definition  of,  384 
elimination  of,  389 
evidences  of,  396 
mode  of  action  of,  385 

of  death  by,  391 
post-mortem  imbibition  of,  402 
Policy,  life  insurance,  376 
Post-mortem  examination,  60 
Potassium  chlorate,  432 
cyanid,  639 
nitrate,  431 
Pregnancy,  210 
concealed,  271 
in  the  dead,  219 
precocious,  217 
signs  of,  211 
unconscious,  218 
Premature  labor,  220 
Presumption  of  death,  73 
Pretended  fasting,  194 
Privet,  650 

Procreative  power,  289 
Protracted  gestation,  277 
Prussic  acid,  630 
Ptomains,  650 


Ptyaiisni,  ihei'CUrial,  488 
Puberty,  290 
Puerperal  mania,  340 
Punctured  wounds,  108 
Putrefaction,  46 

evidences  of,  50 

order  of,  5 1 
Pyromania,  330 

p  APE,  294 

*  ^     anesthesia  in,  301 

on  adults,  300 

on  children,  296 

on  the  dead,  310 
Red  phosphorus,  445 
Reinsch's  test,  463 
Rigidity,  cadaveric,  38 
Rigor  mortis,  38 

SALIVATION,  mercurial,  488 
Salt  of  lemons,  527 
of  sorrel,  527 
Sausage  poison,  540 
Savin,  oil  of,  233,  530 
Scalds  and  burns,  148 
Scheele's  green,  473 
prussic  acid,  630 
Schweinfurt  green,  474 
Seminal  stains,  307 
Senile  dementia,  340 
Sex,  concealed,  288 

doubtful,  288 
Sexual  malformation,  288 
Shot,  wounds  made  by,  118 
Silk,  microscopic  appearance  of,  100 
Skeletons,  age  of,  88 

date  of  interment  of,  96 
identity  of,  87 
sex  of,  92 
stature  of,  93 
Skin  of  new-born  children,  236 
Skull,  evidences  from,  92 
Sleep,  pregnancy  during,  218 
Smothering,  death  by,  157,  264 
Sodium  hydroxid,  426 

salicylate,  533 
Sodomy,  311 
Softening  of  brain,  340 
Solanum,  610 
Somatic  death,  28 
Somnambulism,  341 
Sorrel,  salt  of,  527 


66o 


INDEX. 


Specific  gravity  of  lungs,  241 
Spermatic  stains,  307 
Spermatozoa,  308 
Spine,  concussion  of,  128 
Spontaneous  combustion,  153 
Starch,  detection  of,  251 
Starvation,  death  by,  193 
Static  test,  240 
Sterility,  290 
Still  births,  236 

Stramonium,  poisoning  by,  608 
Strangulation,  163 

accidental,  by  the  umbilical  cord, 
264 
Strychnin,  poisoning  by,  578 
Sublimate,  corrosive,  485 
Subnitrate  of  bismuth,  518 
Suffocation,  death  by,  157 

of  new-born  children,  262 

signs  of,  158 
Sugar,  detection  of,  251 
Suggillation,  43 
Suicidal  mania,  333 

and  life  insurance,  380 

wounds,  113 
Sulphids  of  arsenic,  474 
Sulphuric  acid,  416 
Sunstroke,  189 
Superfetation,  286 
Survivorship,  74 
Syncope  a  cause  of  death,  29 

TANNER,  Dr.,  fast  of,  194 
Tartar  emetic,  474 
Tartaric  acid,  527 
Tattoo  marks,  86 
Teeth   a  test  of  age,  89 

identify  from,  92 
Tenancy  by  courtesy,  281 
Testamentary  capacity,  351 
Tetanus  from  wounds,  123 
Tin,  poisoning  by  salt  of,  519 
Tobacco,  poisoning  by,  613 


Trional,  643 
Tyrotoxicon,  550 

UMBILICAL   cord,  in  dead  and 
live  born  children,  249 
Unconscious  delivery,  271 
intercourse,  218 
pregnancy,   218 

\ /AGINA,  in  rape  of  children,  297 
•      Vaginitis  in  children,  299 
Veratrin,  poisoning  by,  541 
Vertebrae,  fractures  of,  128,  258 
Viability  of  the  child,  280 
Violation,  294 
Virginity,  signs  of,  306 
Volition,  loss  of,  by  anesthesia,  301 
Vulval  penetration,  296,  298 

WADDING,  wounds  by,  I2I 
Wall  paper,  arsenical,  473 
Water  hemlock,  605 
Weapons,  examination  of,  108 
Weight  of  brain  of  new-born  child, 
228 

of  lungs  at  birth,  240 
White  hellebore,  541 
Wills,  capacity  for  making,  352 
Witnesses,  medical,  20 
Wool ,  microscopic  appearance  of,  loo 
Wounds,  cause  of  death  by,  loi 

from  gunpowder,  121 

made  before  and  after  death,  104 

on  new-born  children,  261 

self-inflicted,  208 

upon  the  burned,  1 52 

YELLOW  arsenic,  474 
jasmine,  543 
Yew,  poisoning  by,  649 

'yiNC,  poisoning  by,  513 


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Women.  The  author's  aim  has  been  to  produce  a  book 
that  will  be  thorough  and  practical  in  every  particular.  The 
illustrations,  nearly  all  of  which  are  from  original  sources, 
have  for  the  most  part  been  drawn  by  special  artists  who, 
for  a  number  of  months,  devoted  their  sole  attention  to  this 
work. 

"  The  book  is  one  that  can  be  recommended  to  the  student,  to 
the  general  practitioner — who  must  sometimes  be  a  gynecologist  to 
a  certain  extent  whether  he  will  or  not — and  to  the  specialist,  as  an 
ideal  and  in  every  way  complete  work  on  the  gynecology  of 
to-day — a  practical  work  for  practical  workers." — The  Jour- 
nal 0/  the  American  Medical  Association. 

Byford's  Gynecology 

TKird  Revised  Edition 
A  MANUAL  FOK  STUDENTS   AND   PHYSICIANS 


By  Henry  T.  Byford,  m.d.,  Professor  of  Gynecology  and 
Clinical  Gynecology  in  the  College  of  Physicians  and  Sur- 
geons of  Chicago ;  Professor  of  Clinical  Gynecology, 
Women's  Medical  School  of  Northwestern  University,  and 
in  Post-Graduate  Medical  School,  etc.  Third  Edition,  En- 
larged. 363  Illustrations,  many  of  which  are  from  original 
drawings  and  several  of  which  are  Colored.      l2mo. 

Cloth,  ^3.00 

"  As  a  book  to  help  the  student  to  quickly  review  what  ought 
to  be  gotten  up,  so  as  to  be  prepared  for  the  early  examination,  it  is  of 
great  service.  Such  a  book  would  also  make  a  most  excellent  text- 
book for  the  college  class  room  " —  Virginia  Medical  Semi-Monthly , 
Richmond. 

2 


By   JAMES   TYSON.   M=  D.. 

Professor  of  Medicine,  University  of  Pennsylvania, 
Physician  to  the  Philadelphia  Hospital,  etc. 


The  Practice  of   Medicine.      Second  Edition. 

A  Text-Book  for  Physicians  and  Students,  with  Special  Ref- 
erence to  Diagnosis  and  Treatment.  With  Colored  Plates 
and  many  other  Illustrations.  Second  Edition,  Revised  and 
Enlarged.     127  Illustrations.     8vo.      1222  pages. 

Cloth,  I5. 50;   Leather,  |6. 50;   Half  Russia,  ^7.50 

*^*  This  edition  has  been  entirely  reset  from  new  type. 
The  author  has  revised  it  carefully  and  thoroughly,  and 
added  much  new  material  and  37  new  illustrations. 

"  We  are  firmly  convinced  that  at  the  present  time  Dr.  Tyson's 
book  on  Practice  can  be  most  heartily  commended  to  both  the  practi- 
tioner and  student  as  a  sate,  reliable,  and  thoroughly  up-to-date  guide 
in  the  practice  of  medicine." — Tlie  Therapeutic  Gazette. 

"  The  clinical  descriptions  are  clear  and  full,  and  the  methods  of 
treatment  described  are  those  generally  recognized  as  being  the  most 
modern  and  satisfactory." — The  London  Lancet. 

Guide  to  the  Examination  of   Urine.     Tenth 
Editiorv. 

For  the  Use  of  Physicians  and  .Students.  With  Colored 
Plate  and  Numerous  Illustrations  Engraved  on  Wood. 
Tenth  Edition,  Revised,  Enlarged,  and  in  many  parts  entirely 
rewritten.  Cloth,  ^1.50 

*.^.*  A  French  translation  of  this  book  has  been  pub- 
lished in  Paris. 

"  The  book  is  probably  more  widely  and  generally  known  and  ap- 
preciated than  any  of  its  similars  in  subject  and  scope." — JVew  York 
Medical  Joiirnal. 

"  The  book  is  a  reliable  one,  and  should  find  a  place  in  the  library 
of  every  practitioner  and  student  c  f  medicine." — Boston  Medical  and 
Surgical  Journal. 

Ha.ndbcok   of   Physica^l   Dia.gno£is.     Fourth 
Edition. 

Revised  and  Enlarged.  With  two  Colored  Plates  and  55 
other  Illustrations.      298  pages.      l2mo.  Cloth,  ^1.50 

"  T^ike  everything  else  emanating  from  this  distinguished  author 
this  little  book  is  replete  with  practical  information  from  beginning  to 
end." — The  Chicago  Rledical  Recorder. 

"  The  author  approaches  his  subject  from  a  practical  point  of 
view  and  the  little  work  will  prove  a  good  friend  to  the  student." — 
The  Atfierican  Journal  of  the  Medical  Sciencet. 

3 


NEW  THIRD  EDITION— JUST  READY 

MORRIS'  Anatomy 

Rewritten — Revised — Improved 
WITH  MANY  NEW  ILLUSTRATIONS 


Out  of  I02  of  the  leading  medical  schools  60  recommend 
"Morris."  It  contains  many  features  of  special  advantage 
to  students.  It  is  modtrn,  up-to-daie  in  every  respect.  It 
has  been  carefully  revised,  the  articles  on  Osteology  and 
Nervous  System  having  been  rewritten.  Each  copy  con- 
tains the  colored  illustrations  and  a  Thumb  Index. 

Octavo.     With  846  Illustrations,  of  which  267  arc 
printed  in  colors. 

CLOTH,  $6.00;  LEATHER,  $7.00 


"The  ever  growing  popularity  of  the  book  with  teachers  and  stu- 
dents is  an  index  of  its  value,  and  it  may  safely  be  recommended  to  all 
interested." — From  llie  Medical  Record,  New  York. 

"Of  all  the  text  books  of  moderate  size  on  human  anatomy  in  the 
English  language,  Morris  is  uiidoubiedly  the  most  up  to-date  and  accu- 
rate."— From  ihe  Fhiladetphia  Medical  Journal . 


mcMurrich — rLmbryoIogy 

Just  Ready.     276  Illustrations 


A  Text-Book  for  Medical  Students.  By  J.  Playfair 
McMurrich,  Professor  of  Anatomy,  Medical  Department, 
University  of  Michigan.     500  pages.  Cloth,  ^3.00 


4 


NINTH  EDITION 


POTTER^S  MATERIA  MEDICA, 
PHARMACY,  AND  THERAPEUTICS 

An  Exhaustive  Handbook 


Including  the  Action  of  Medicines,  Special  Therapeutics  of 
Disease,  Official  and  Practical  Pharmacy,  and  Minute  Direc- 
tions for  Prescription  Writing,  etc.  Including  over  650 
Prescriptions  and  Formulae.  By  Samuel  O.  L.  Potter 
M.A.,  M.D.,  M.R.c.p.  (Lond.),  formerly  Professor  of  the 
Principles  and  Practice  of  Medicine,  Cooper  Medical  Col- 
lege, San  Francisco  ;  Major  and  Brigade  Surgeon,  U.  S. 
Vol.  Ninth  Edition,  Revised  and  Enlarged.  8vo. 
With  ThuDib  Index  in  each  copy. 

Cloth,  ^5.00  ;  Leather,  ^6.00 
\*This  is  the  most  complete  ai,d  trustworthy  book 
for  the  use  of  students  and  physicians.  Students  w  ho  pur- 
chase it  will  find  it  to  contain  a  vast  deal  of  information  not 
in  the  usual  text-books  arranged  in  the  most  practical  man- 
ner for  facilitating  study  and  reference.  It  cannot  be  sur- 
passed as  a  physician's  working  book. 

WHITE  AND  WILCOX.  Materia  Medica, 
Pharmacy,  Pharmacology,  and  Thera- 
peutics.    Fifth  Edition. 

A  Handbook  for  Students.  By  W.  Hale  White,  m.d., 
F.R.C.P.,  etc..  Physician  to,  and  Lecturer  on  Materia 
Medica  and  Therapeutics  at,  Guy's  Hospital,  etc.  Fifth 
American  Edition,  Revised  by  Reynold  W.  Wilcox 
M  A  ,  M.  D. ,  LL.D. ,  Professor  of  Clinical  Medicine  and  Thera- 
peutics at  the  New  York  Post- Graduate  Medical  School  and 
Hospital ;  Visiting  Physician,  St.  Mark's  Hospital ;  Assist- 
ant Visiting  Physician,  Belleviie  Hospital.      i2mo. 

Cloth,  ^3.00  ;   Leather,  ^3.50 
5 


SUBJECT  INDEX. 


Gould's  Medical  Dictionaries,  =  =  Page  l2 
Morris'  Anatomy,  JNew  Edition,  =  Page  4 
Compends  for  Students,      =        =        =      Page  26 


SUBJECT  PAGE 

Alimentary  Canal  (see  Surgeiy)  23 

Anatomy 7 

Anesthetics 18 

Autopsies  (see  Pathology) 20 

Bacteriology  (see  Pathology)..  20 

Bandaging  (see  Surgery) 23 

Blood,  Examination  of 20 

Brain  8 

Chemistry.     Physics 8 

Children,  Diseases  of 10 

Climatology 18 

Clinical  Charts 24 

Compends  26 

Consumption  (see  Lungs) 15 

Cyclopedia  of  Medicine  12 

Dentistry 11, 

Diabetes  (see  Urin.  Organs)..  24 

Diagnosis 10 

Diagrams  (see  Anatomy) 7 

Dictionaries,  Cyclopedias 12 

Diet  and  Food 18 

Disinfection  15 

Dissectors 7 

Ear 13 

Electricity  13 

Embryology 7 

Emergencies 23 

Eye 13 

Fevers 14 

Food 18 

Formularies 21 

Gynecology  25 

Hay  Fever 24 

Heart , 14 

Histology 14 

Hydrotherapy 18 

Hygiene 15 

Hypnotism  8 

Insanity  8 

Intestines 22 

Latin,  Medical  (see  Miscella- 
neous and  Pharmacy) 18,20 

Life  Insurance 18 

Lungs 15 

Massage 16 

Materia  Medica 16 


SUBJECT.  PAGE 

Mechanotherapy 16 

Medical  Jurisprudence 17 

Mental  Therapeutics 8 

Microscopy  17 

Milk  Analysis  (see  Chemistry)  8 

Miscellaneous  18 

Nervous  Diseases  18 

Nose 24 

Nursing 19 

Obstetrics 20 

Ophthalmology 13 

Organotherapy 18 

Osteology  (see  Anatomy) 7 

Pathology  20 

Pharmacy 20 

Physical  Diagnosis 11 

Physical  Training  16 

Physiology  21 

Pneumotherapy 18 

Poisons  (see  Toxicology) 17 

Practice  of  Medicine 22 

Prescription  Books  (Pharm'y),  21 

Refraction  (see  Eye) 13 

Rest 18 

Sanitary  Science 15 

Skin 23 

Spectacles  (see  Eye) 13 

Spine  (see  Nervous  Diseases)  18 

Stomach 22 

Students'  Compends  26 

Surgery  and  Surg'l   Diseases,  23 

Technological  Books 8 

Temperature  Charts 24 

Therapeutics 16 

Throat  24 

Toxicology 17 

Tumors  (see  Surgery) 23 

U.  S.  Pharmacopoeia 21 

Urinary  Organs 24 

Urine 24 

Venereal  Diseases 25 

Veterinary  Medicine 25 

Visiting  Lists,  Physicians'. 
{Send /or  Special  Circular.) 

Water  Analysis 15 

Women,  Diseases  of. 25 


Self-Examination  for  Medical  Students.  3500  Questions  on 
Medical  Subjects,  with  References  to  Standard  Works  in  which  the 
correct  replies  will  be  found.  Together  with  Questions  from  State 
Examining  Boards.     3d  Edition.     Paper  Cover,  10  cts. 


SUBJECT  CATALOGUE  OF  MEDICAL  BOOKS.  1 

SPECIAL,  ^OTJS.— The  prices  given  in  this  catalogue  are 
net,  no  discount  can  be  allowed  retail  purchasers  under  any  considera- 
tion. This  rule  has  been  established  in  order  that  everyone  will  be 
treated  alike,  a  general  reduction  in  former  prices  having  been  made  to 
meet  previous  retail  discounts.  Upon  receipt  of  the  advertised  price  any 
book  will  be  forwarded  by  mail  or  express,  all  charges  prepaid. 


ANATOMY.     EMBRYOLOGY. 

MORRIS.  Text-Book  of  Anatomy.  Third  Revised  and  Enlarged 
Edition.  846  Illustrations,  267  of  which  are  printed  in  colors.  Thumb 
Index  in  Each  Copy.  Cloth,  S6.00  ;  Leather,  %^  00 

"  The  ever-growing  popularity  of  the  book  with  teachers  and  students 

is  an  index  of  its  value." — Medical  Record,  New  York. 

BROOMELL.  Anatomy  and  Histology  of  the  Human  Mouth 
and  Teeth.     2d  Edition,  Enlarged.     337  Illustrations.  %a,  50 

CAMPBELL.  Dissection  Outlines.  Based  on  Morris' Anatomy. 
2d  Edition.  .50 

DEAVER.     Surgical  Anatomy.     A   Treatise  on  Anatomy   in  its 
Application  to  Medicine  and  Surgery.    With  480  very  Handsome  full- 
page  Illustrations  Engraved  from  Original  Drawings  made  by  special 
Artists  from  dissections  prepared  for  the  purpose.     Three  Volumes. 
Cloth,  $21  00;   Half  Morocco  or  Sheep,  J24. 00;   Half  Russia,  $2700 

GORDINIER.  Anatomy  of  the  Central  Nervous  System. 
With  271  Illustrations,  many  of  which  are  original.  Cloth,  g6.oo 

HEATH.     Practical  Anatomy.    8th  Edition.    300  lUus.  J4.25 

HOLDEN.  Anatomy.  A  Manual  of  Dissections.  Revised  by  A. 
Hewson,  M.D.,  Demonstrator  of  Anatomy,  Jefferson  Medical  College, 
Philadelphia,  vo  handsome  Illustrations.  7th  Edition.  In  two 
compact  i2mo  Volumes.  850  Pages.  Large  New  Type. 
Vol.  I.  Scalp— Face— Orbit— Neck— Throat— Thorax— Upper  Ex- 
tremity. $1.50 
Vol  II  Abdomen — Perineum — Lower  Extremity— Brain — Eye — 
Ear— Mammary  Gland — Scrotum — Testes.                Ji-5o 

HOLDEN.  Human  Osteology.  Comprising  a  Description  of  the 
Bones,  with  Colored  Delineations  of  the  Attachments  of  the  Muscles. 
The  General  and  Microscopical  Structure  of  Bone  and  its  Develop- 
ment    With  Lithographic  Plates  and  numerous  I Uus.   8th  Ed.     $5.25 

HOLDEN.     Landmarks.     Medical  and  Surgical      4th  Ed.  .75 

HUGHES  AND  KEITH.  Dissections.  With  527  Colored  Plates 
and  other  lllu.trations.     In  three  farts.    Just  Ready. 

I,  Upper  and  Lower  Extremity.  iSs.oo 

II,  Abdomen — Thorax  $3-oo 

III,  Head — Neck — Central  Nervous  System.  I300 

MACALISTER.  Human  Anatomy.  Systematic  and  Topograph- 
ical     8ifi  Illnstrations.  Cloth,  ^5.00  ;  Leather,  J6.00 

McMURRICH.  Embryology.  The  Developmen;  of  the  Human 
Body.     270  Illustrations.  JS3.00 

MARSHALL.  Physiological  Diagrams.  Eleven  Life-Size 
Colored  Diagrams  (each  seven  feet  by  three  feet  seven  inches). 
Designed  for  Demonstration  before  the  Class. 

In  Sheets,  Unmounted,  $40.00  ;  Backed  with  Muslin  and  Mounted 
on  RoUers,  $60.00 ;  Ditto,  Spring  Rollers,  in  Handsome  Walnut  Wall 
Map  Case,  $100.00;  Single  Plates — Sheets.  $5.00 ;  Mounted,  $7.50 
Explanatory  Key,  .i;o      Purchaser  must  pay  freight  charges. 

MINOT.     Embryology.     Illustrated.  In  Press. 

POTTER.  Compend  of  Anatomy,  Including  Visceral  Anatomy. 
6th  Ed.    16  Lith.  Plates  and  117  other  lUus.     .80  ;  Interleaved,  $1.00 

WILSON.    Anatomy,     nth  Edition.     i,qi<)  Illus.,  a6  Plates.      $5.00 
9-29-oz, 


SUBJECT  CATALOGUE. 


BRAIN  AND  INSANITY  (see  also 
Nervous  Diseases). 

BLACKBURN.  A  Manual  of  Autopsies.  Designed  lor  the  Use 
of  Hospitals  for  the  Insane  and  other  Public  Institutions.  Ten  fuli- 
page  Plates  and  other  Illustrations.  Ji-25 

CHASE.     General  Paresis.     Illustrated.    Just  Ready.  $\  75 

DERCUM.  Mental  Therapeutics,  Rest,  Suggestion.  See 
Cohen,  Physiocogic  Therapeutics,  page  ib. 

GORDINIER.  The  Gross  and  Minute  Anatomy  of  the  Central 
Nervous  System.     With  full-page  and  other  Illustrations.      J6.00 

HORSLEY.  The  Brain  and  Spinal  Cord.  The  Structure  and 
Functions  of.     Numerous  Illustrations.  $2-5° 

IRELAND.    The  Mental  Affections  of  Children.    2d  Ed.    $4.00 

LEWIS  (BEVAN).  Mental  Diseases.  A  Text-Book  Having 
Special  Reference  to  the  Pathological  Aspects  of  Insanity.  26  Litho- 
graphic Plates  and  other  Illustrations.     2d  Ed.  ^57.00 

MANN.    Manual  of  Psychological  Medicine,  $3-°o 

PERSHING.  Diagnosis  of  Nervous  and  Mental  Disease. 
Illustrated  t^-'^S 

REGIS.  Mental  Medicine.  Authorized  Translation  by  H.  M. 
Bannister,  m.d.  ^2.00 

SCHOFIELD.     The  Force  of  Mind.    Just  Ready.  $2.00 

STEARNS.  Mental  Diseases.  With  a  Digest  of  Laws  Relating 
to  Care  of  Insane.     Illustrated.  Cloth,  ^2.75;  Sheep,  I3. 25 

TUKE.  Dictionary  of  Psychological  Medicine.  Giving  the 
Definition,  Etymology,  and  Symptoms  of  the  Terms  used  in  Medical 
Psychology,  with  the  Symptoms,  Pathology,  and  Treatment  of  the 
Recognized  Forms  of  Mental  Disorders.     Two  volumes.  $10.00 

WOOD,  H.  C.    Brain  and  Overwork.  .40 

CHEMISTRY  AND  TECHNOLOGY. 

special  Catalogue  of  Chemical  Books  sent  free  upon  application. 

ALLEN.     Commercial   Organic    Analysis.     A  Treatise  on  the 

Modes   of  Assaying  the  Various  Organic  Chemicals  and  Products 

Employed   in  the   Arts,  Manufactures,  Medicine,  etc.,  with  concise 

methods  for  the  Detection  of  Impurities,  Adulterations,  etc.     8vo. 

Vol.  I.  Alcohols,  Neutral  Alcoholic  Derivatives,  etc..  Ethers,  Veg- 
etable Acids,  Starch,  Sugars,  etc.     3d  Edition.  J4.50 

Vol.  II,  Part  I.  Fixed  Oils  and  Fats,  Glycerol,  Explosives,  etc. 
3d  Edition.  fo-5o 

Vol.  II,  Part  II.  Hydrocarbons,  Mineral  Oils,  Lubricants,  Benzenes, 
Naphthalenes  and  Derivatives,  Creosote,  Phenols, etc.  3d  Ed.  ;^3.5o 

Vol.  II,  Part  III.  Terpenes,  Essential  Oils,  Resins,  Camphors,  etc. 
3d  Edition.  Prepjiring. 

Vol.  Ill,  Part  I.  Tannins,  Dyes  and  Coloring  Matters.  3d  Edition. 
Enlarged  and  Rewritten.     Illustrated.  J4.50 

Vol.  Ill,  Part  II.  The  Amines,  Hydrazines  and  Derivatives, 
Pyridine  Bases.  The  Antipyretics,  etc.  Vegetable  Alkaloids,  Tea, 
Coffee,  Cocoa,  etc.     8vo.    2d  Edition.  %^■1fi 

Vol.  Ill,  Part  III.  Vegetable  Alkaloids,  Non-Basic  Vegetable  Bitter 
Principles.  Animal  Bases,  Animal  Acids,  Cyanogen  Compounds, 
etc.     2d  Edition,  8vo.  $4-5° 

Vol.  IV.  The  Proteids  and  Albuminous  Principles.  2d  Ed.  $4.50 
BAILEY  AND  CADY.     Qualitative  Chemical  Analysis,    $1.25 


MEDICAL  BOOKS. 


BARTLEY.    Medical    and    Pharmaceutical    Chemistry.     A 

lext-Book  for  Medical,  Dental,  and  Pharmaceutical  Students     With 

Illustrations,  Glossary,  and  Complete  Index.     5th  Edition  «3  00 

HARTLEY.     Clinical  Chemistry.      The   Examination  of  Feces. 

Saliva,  Gastric  Juice,  Milk,  and  Urine.  ji  qq 

BLOXAM      Chemistry,  Inorganic  and  Organic.     With  Experi- 

^T^^r^^  9      ^'^-  ^^"""^"^       '^'  Engravines  Pre/arzng: 

Y^^,,^'r   P'^y^i,°',°gi^a,'id  Pathologic  Chemistry.     From  the 

l-ourth  German  Enlarged  kdition.    Just  Ready.  «,  00 

Chii,Y.f^h    Elements    of   Quahtative"^ and    Qu.ntitatlv^ 

Chemical  Analysis.     3d  Edition,  Revised.  «,  00 

CAMERON.     Oils  and  Varnishes.     With  Illustrations.  %i.^s 

CAMERON.     Soap  and  Candles.    54  Illustrations  J2  00 

CLOWES  AND   COLEMAN.      Quantitative   Analysis.      5th 

t-dition.     122  Illustrations  '  <, 

COBLENTZ.     Volumetric  Analysis.    Illustrated.  i,  2° 

CONGDON  Laboratory  Instructions  in  Chemistry.  With 
Numerous  Tables  and  56  Illustrations.  j,  00 

''ft^e'^r.^'^lfustrlt^I  ^'■'^•'^'    ^•^«""-    "'^    ^ine    Manufac- 

GRAY  Physics.  Volume  I.  Dynamics  and  Properties  of  Matter 
350  i 'lustrations.  4 

GROVES  AND  THORP.     Chemical  Technology.     The  ApplU 
cation  of   Chemistry   to  the   Arts  and   Manufactures 
Vol.  I.   Fuel  and  lu  Applications.     607  Illustrations  and  4  Plates, 
v^i    Ti     T  •   u  ■  Ti,  ,  Cloth,  J5.00;  >^Mor.,«6.5o 

Vo  "  f  i    r'^  l'"t-    ^""^"'^t^'i-  ^'°th.  I4.00     y,  Mor.   15.50 

HFtI<=iT  F^      Tl^  ^n'^''""^-     ■P'J°'°"'"'T.  In  Press. 

t;5y?^E^-     Thelerpenes.    Just  Ready.  «.  ^n 

HOLLAND.  The  Urine,  the  Gastric  Contents,  the  Common 
Poisons,  and  the  Milk.  Memoranda,  Chemical  and  Microscopi- 
cal, for  Laboratory  Use.     6th  Ed.     Illustrated  and  interleaved   %i  00 

^^11^^^'^-    ^°^S^'"^    °^   Medical    Chemistrv,  Inorganic 

and  Organic.     4th  Edition,  Revised.  .80  ;  Interleaved  Voo 

LEFFMANN       Analysis   of   Milk   and   Milk    Products.     2d 

i-dition.  Enlarged.     Illustrated.  »i  ^r 

^S'^tif'^-  .  ^^^"l  Analysis.  For  Sanitary  and  Technic  Pur- 
poses.    Illustrated.     4th  Edition.  g, 

LEFFMANN  Structural  Formulae.  Including  180  Structural 
and  Stereo-Chemical  Formulae.     lamo.     Interleaved  «t  ^ 

LEFFMANN  AND  BEAM.  Select  Methods  in  Food  Anil^! 
SIS.     Illustrated  g,    -' 

MUTER.  Practical  and  Analytical  Chemistry.  2d  Amedcan 
from  the  Eighth  English  Edition.  Revised  to  meet  the  reqSrements 
of  American  Students.     56  Illustrations.  «i  25 

nPT^f^'     f;'e'''=i"s  in  Electro-chemistry.    Illustrated.        .'7, 
^fr^J^^^    Electro-Chemical  Experiments.     Illustrated.         .7, 
rnin   P^>*     ^""/^f ''i.':  Chemistry.    5th  American  from  loth  Ger- 
man  Edition.     Authorized  translation  by  Edgar  F.   Smith    m  a 
PH.D.     89  Illustrations  and  a  Colored  Plate.  Si  7.I 

fromTh^f;h  p '■^*°'^^&*'"'^*iy-c.  3d  American  Edition.  T?ans. 
vT  ^ir^^'"''?''^^''''''''  ^- Smith.  Illustrated.  2  Volumes. 
Vo  .    I.    Aliphatic  Series.     625  Pages.  ,"!^ 

Vol.  II.    Carbocyclic  Series.     671  Pages.  I300 


10  SUBJECT  CATALOGUE. 

ROCKWOOD.  Chemical  Analysis  for  Students  of  Medicine, 
Dentistry,  and  Pharmacy.     Illustrated.  Ji-So 

SMITH,     Electro-Chemical  Analysis.    3d  Ed.     39   Illustrations. 

Nearly  Ready. 

SMITH  AND  KELLER.  Experiments.  Arranged  for  StudenU 
in  General  Chemistry.     4th  Edition.     Illustrated  .60 

SUTTON.  Volumetric  Analysis.  A  Systematic  Handbook  for 
the  Quantitative  Estimation  of  Chemical  Substances  by  Measure, 
Applied  to  Liquids,  Solids,  and  Gases.  8th  Edition,  Revised.  112 
Illustrations.  ^5.00 

SYMONDS.     Manual  of  Chemistry.     2d  Edition.  J2.00 

TRAUBE.  Physico-Chemical  Methods.  Translated  by  Hardin. 
97  Illustrations.  J1.50 

THRESH.     Water  and  \A^ater  Supplies.     3d  Edition.  J2.00 

ULZER  AND  FRAENKEL.  Chemical  Technical  Analysis. 
Translated  by  Fleck.     Illustrated.  $1.25 

WOODY.  Essentials  of  Chemistry  and  Urinalysis.  4th 
Edition.     Illustrated.  Ji-So 

*»*  Special  Catalogue  of  Books  on  Chemistry  free  upon  application . 

CHILDREN. 

HATFIELD.       Compend  of  Diseases   of    Children.      With    a 

Colored  Plate.     3d  Edition.     Just  Ready.  80;    Interleaved,  $1.00 

IRELAND.  The  Mental  AfTections  of  Children.  Idiocy, 
Imbecility,  Insanity,  etc.     2d  Edition.  J4.00 

POWER.  Surgical  Diseases  of  Children  and  their  Treat- 
ment by  Modern  Methods.     Illustrated.  J2.50 

STARR.  The  Digestive  Organs  in  Childhood.  The  Diseases  of 
the  Digestive  Organs  in  Infancy  and  Childhood.  3d  Edition,  Rewrit- 
ten and  Enlarged.     Illustrated.  $3  co 

STARR.  Hygiene  of  the  Nursery.  Including  the  General  Regi- 
men and  Feeding  oi  Infants  and  Children,  and  the  Domestic  Manage- 
ment of  the  Ordinary  Emergencies  of  Early  Life,  Massage,  etc.  6th 
Edition.     25  Illustrations.  Ji.oo 

SMITH.     Wasting  Diseases  of  Children.    6th  Edition.        J2.00 

TAYLOR  AND  WELLS.  The  Diseases  of  Children.  2d  Edi- 
tion, Revised  and  Enlarged.     Illustrated.     8vo.  $4-5o 

"  It  is  well  worthy  the  careful  study  of  both  student  and  practitioner, 
and  can  not  fail  to  prove  of  great  value  to  both.  We  do  not  hesitate 
to  recommend  it." — Boston  Medical  and  Surgical  Journal. 

DIAGNOSIS. 

BROWN.  Medical  Diagnosis.  A  Manual  of  Clinical  Methods. 
4th  Edition.     112  Illustrations.  Cloth,  J2. 25 

DA  COSTA.  Clinical  Hematology.  A  Piactical  Guide  to  Exam- 
ination of  Blood.  6  Colored  Plates.  48  other  Illustrations.  Just 
Ready.  Cloth,  ^5.00;  Sheep,  $6.00 

EMERY.  Bacteriological  Diagnosis.  2  Colored  Plates  and  32 
other  Illustrations.     Just  Ready.  ?t-5o 

MEMMINGER.   Diagnosis  by  the  Urine.   2d  Ed.   24  Illus.  |i.oo 


MEDICAL  BOOKS. 


PERSHING.    Diagnosis  of  Nervous  and   Mental  Diseases. 

Illustrated.  ?i-2S 

STEELL.     Physical  Signs  of  Pulmonary  Disease,  ^1.25 

TYSON.  Hand-Book  of  Physical  Diagnosis.  For  Students  and 
Physicians.  By  the  Professor  of  Clinical  Medicine  in  the  University 
of  Pennsylvania.  lUus.  4th  Ed.,  Improved  and  Enlarged.  With 
Two  Colored  and  55  other  Illustrations.  |i.SO 


DENTISTRY. 

special  Catalogue  of  Dental  Books  sent  free  upon  application. 

BARRETT.  Dental  Surgery  for  General  Practitioners  and 
Students  of  Medicine  and  Dentistry.  Extraction  of  Teeth, 
etc.     3d  Edition.     Illustrated.  $1.00 

BROOMELL.  Anatomy  and  Histology  of  the  Human  Mouth 
and  Teeth.  Second  Edition,  Revised  and  Enlarged.  337  Hand- 
some Illustrations.  Cloth,  ^4.50;   Leather,  $5.50 

FILLEBROWN.      A    Text-Book     of    Operative     Dentistry. 

Written  by  invitation  of  the  National  Association  of  Dental  Facul- 
ties.    Illustrated.  ?2-2S 

QORGAS.  Dental  Medicine.  A  Manual  of  IVIateria  Medica  and 
Therapeutics.    7th  Edition.  Cloth,  J4. 00;  Sheep,  I5.00 

GORGAS.     Questions  and  Answers  for  the  Dental  Student. 

Embracing  all  the  subjects  in  the  Curriculum  of  the  Dental  Student. 
Octavo.  J6.00 

HARRIS.  Principles  and  Practice  of  Dentistry.  Including 
Anatomy,  Physiology,  Pathology,  Therapeutics,  Dental  Surgery, 
and  Mechanism.  13th  Edition.  Revised  by  F.  J.  S.  Gorgas,  m.d., 
D.D.s.     1250  Illustrations.  Cloth,  J6.00;  Leather,  I7.00 

HARRIS.  Dictionary  of  Dentistry.  Including  Definitions  of  Such 
Words  and  Phrases  of  the  Collateral  Sciences  as  Pertain  to  the  Art  and 
Practice  of  Dentistry.  6th  Edition.  Revised  and  Enlarged  by  Fer- 
dinand F.  S.  Gorgas,  m.d.,  d.d.s.  Cloth,  J5.00;  Leather,  f6.oo 

RICHARDSON.  Mechanical  Dentistry.  7th  Edition.  Thor- 
oughly Revised  and  Enlarged  by  Dr.  Geo.  W.  Warren.  691  Illus- 
trations. Cloth,  Js. 00;  Leather,  J6.00 

SMITH.    Dental  Metallurgy.    2d  Edition.    Illustrated.    InPress. 

TAFT.    Index  of  Dental  Periodical  Literature.  $2.00 

TOMES.     Dental  Anatomy.    Human  and  Comparative.    263  Illus- 
trations.    5th  Edition.  J4.00 
TOMES.     Dental  Surgery.    4th  Edition.     289  Illustrations.     J4.00 

WARREN.  Compend  of  Dental  Pathology  and  Dental  Medi- 
cine.    With  a  Chapter  on  Emergencies.     3d  Edition.     Illustrated. 

.80;  Interleaved,  $1.25 

WARREN.  Dental  Prosthesis  and  Metallurgy.  129  Ills,  fi.25 
WHITE.     The  Mouth  and  Teeth,     Illustrated.  .40 


12  SUBJECT  CATALOGUE. 

DICTIONARIES  AND  CYCLOPEDIAS 

QOULD.  The  Illustrated  Dictionary  ot  Medicine,  Biology 
and  Allied  Sciences.  Being  an  Exhaustive  Lexicon  of  Medicine 
and  those  Sciences  Collateral  to  it:  Biology  (Zoology  and  Botany), 
Chemistry,  Dentistry,  Parmacology,  Microscopy,  etc.,  with  many 
usefiil  Tables  and  numerous  fine  Illustrations.  1633  pages.  5th  Ed. 
Sheep  or  Half  Morocco,  ;Jio.oo  ;  with  Thumb  Index,  Jii.oo 
Half  Russia,  Thumb  Index,  |i2.co 

QOULD.  The  Medical  Student's  Dictionary,  nth  Edition. 
Illustrated.  Including  all  the  Words  and  Phrases  Generally  Used 
inMedicine,  with  their  Proper  Pronunciation  and  Definition,  Based 
on  Recent  Medical  Literature.  With  Table  of  Eponymic  Terms  and 
Tests  and  Tables  of  the  Bacilli,  Micrococci,  Mineral  Springs,  etc., 
of  the  Arteries,  Muscles,  Nerves,  Ganglia,  Plexuses,  etc.  nth  Edi- 
tion. Enlarged  and  illustrated  with  a  large  number  of  Engravings. 
840  pages.  Half  Morocco,  ^2.50;  with  Thumb  Index,  >3  00 

QOULD.  The  Pocket  Pronouncing  Medical  Lexicon.  4th  Edi- 
tion. (30,000  Medical  Words  Pronounced  and  Defined.)  Containing 
all  the  Words,  their  Definition  and  Pronunciation,  that  the  Medical, 
Dental,  or  Pharmaceutical  Student  Generally  Comes  in  Contact 
With ;  also  Elaborate  Tables  of  Eponymic  Terms.  Arteries,  Muscles, 
Nerves,  Bacilli,  etc.,  etc.,  a  Dose  List  in  both  English  and  Metric 
Systems,  etc..  Arranged  in  a  Most  Convenient  Korm  for  Reference  and 
Memorizing.  Fourth  Edition,  Revised  and  Enlarged.  838 
pages.  Full  Limp  Leather,  Gilt  Edges,  |i.oo  ;  Thumb  Index,  J1.25 
140,000  Copies  of  Gould's  Dictionaries  Have  Been  Sold. 

GOULD  AND  PYLE.  Cyclopedia  of  Practical  Medicine  and 
Surgery.  Seventy-two  Special  Contributors.  Illustrated. 
One  Volume.  A  Concise  Reference  Handbook  of  Medicine, 
Surgery,  Obstetrics,  Materia  Medica,  Therapeutics,  and  the  Various 
Specialties,  with  Particular  Reference  to  Diagnosis  and  Treatment. 
Compiled  under  the  Editorial  Supervision  of  George  M.  Gould, 
M.D.,  Author  of  "  An  lUustrateo  Dictionary  of  Medicine,"  etc.; 
and  Walter  L.  Pyle,  m.d..  Assistant  Surgeon  Wills  Eye 
Hospital  ;  formerly  Editor  "  International  Medical  Magazine,"  etc., 
and  Seventy-two  Special  Contributors.  With  many  Illustrations. 
Large  Square  8vo,  to  correspond  with  Gould's  "  Illustrated  Dic- 
tionary." FuUSheepor  Half  Mor  ,$10.00;  with  Thumb  Index, Jii.co 
Half  Russia,  Thumb  Index.  $12.00  net. 

GOULD  AND  PYLE.  Pocket  Cyclopedia  of  Medicine  and 
Surgery.  Based  upon  above  book  and  uniform  in  size  with  "  Gould's 
Pocket  Dictionary." 

Full  Limp  Leather.  Gilt  Edges,  Ji.oo,  with  Thumb  Index,  $1.25 

HARRIS.  Dictionary  of  Dentistry.  Including  Definitions  of  Such 
Words  and  Phrases  of  the  Collateral  Sciences  as  Pertain  to  the  Art 
and  Practice  of  Dentistry.  6th  Edition.  Revised  and  Enlarged  by 
Ferdinand  J.  S.  GoRGAS,  M.D. ,  D.D.s.   Cloth,  $s-oo;  Leather,  $6.00 

LONGLEY.     Pocket  Medical  Dictionary.  Cloth,  .75 

MAX^VELL.  Terminologia  Medica  Polyglotta.  By  Dr. 
Theodore  Maxwell,  Assisted  by  Others.  $3-°° 

The  object  of  this  work  is  to  assist  the  medical  men  of  any  nationality 

In   reading   medical  literature  written   in  a  langiiage  not   their  own. 

Each  term  is  usually  given  in  seven  languages,  viz. :  English,  French, 

German,  Italian,  Spanish,  Russian,  and  Latin. 

TREVES  AND  LANG.    German-English  Medical  Dictionary . 

Half  Calf,  I3.2S 


MEDICAL  BOOKS. 


KAR  (see  also  Throat  and  Nose). 

BURNETT.     Hearing  and  How  to  Keep  It.     Illustrated.  .40 

HOVELL.  Diseases  ot  the  Ear  and  Naso-Pharynx.  Includ- 
ing Anatomy  and  Physiology  of  the  Organ,  together  with  the  Treat- 
ment of  the  Affections  of  the  Nose  and  Pharynx  which  Conduce  to 
Aural  Disease.     128  Illustrations.     2d  Edition.  ^S-S" 

PRITCHARD.  Diseases  of  the  Ear.  3d  Edition,  Enlarged. 
Many  Illustrations  and  Formulae.  $^-5° 


ELECTRICITY. 

BIGELOAV.  Plain  Talks  on  Medical  Electricity  and  Bat- 
teries. With  a  Therapeutic  Index  and  a  Glossary.  43  Illustra- 
tions.    2d  Edition.  ^i.oo 

HEDLEY.  Therapeutic  Electricity  and  Practical  Muscle 
Testing,     qq  Illustrations.  '  J2.50 

JACOBY.      Electrotherapy.      2    Vols.    Illustrated.      See    Cohen, 

Physiologic  Therapeutics,  page  lb. 
JONES.   Medical  Electricity.  3d  Edition.   117  lUus.  $3.00 


EYE. 

A  Special  Circular  of  Books  on  the  Eye  sent  free  upon  application. 

DONDERS.  The  Nature  and  Consequences  of  Anomalies  of 
Refraction.     With  Portrait  and  Illustrations.     Half  Morocco,  f  1.25 

KICK.  Diseases  of  the  Eye  and  Ophthalmoscopy.  Trans- 
lated by  A.  B.  Hale,  m.  d.  157  Illustrations,  many  of  which  are  in 
colors,  and  a  glossary.  Cloth,  ^4.50  ;  Sheep,  Js.50 

GOULD  AND  PYLE.  Compend  of  Diseases  of  the  Eye  and 
Refraction.  Including  Treatment  and  Operations,  and  a  Section 
on  Local  Therapeutics.  With  Formulae,  Useful  Tables,  a  Glossary, 
and  III  Illus.,  several  of  which  are  in  colors.     2d  Edition,  Revised. 

Cloth,  .80  ;   Interleaved,  Ji.oo 

GREEFF.  The  Microscopic  Examination  of  the  Eye.  Illus- 
trated. J1.25 

HARLAN.    Eyesight,  and  How  to  Care  for  It.     Illus.  .40 

HARTRIDGE.  Refraction.  104  Illustrations  and  Test  Types, 
nth  Edition,  Enlarged.  ^1.50 

HARTRIDGE.  On  the  Ophthalmoscope.  4th  Edition.  With 
4  Colored  Plates  and  68  Wood-cuts.  $1.50 

HANSELL  AND  REBER.     Muscular  Anomalies  ot  the  Eye. 

Illustrated.  |i.50 

HANSELL  AND  BELL.  Clinical  Ophthalmology.  Colored 
Plate  of  Normal  Fundus  and  120  Illustrations.  Ji.So 

JENNINGS.  Manual  of  Ophthalmoscopy.  95  Illustrations  and 
I  Colored  Plate.  I1.50 


14  SUBJECT  CATALOGUE. 

MORTON.    Refraction  ol  the  Eye.    Its  Diagnosis  and  the  Cor- 
rection of  its  Errors.     6th  Edition.  Ji.oo 

OHLEMANN.     Ocular  Therapeutics.    Authorized  Translation, 
and  Edited  by  Dr.  Charles  A.  Oliver.  f'-75 

PARSONS.     Elementary  Ophthalmic  Optics.     With  Diagram- 
matic Illustrations.  J2.00 

PHILLIPS.     Spectacles  and  Eyeglasses.      Their  Prescription 
and  Adjustment.     2d  Edition.      49  Illustrations.  Ji.oo 

SWANZY.     Diseases  of  the  Eye  and  Their  Treatment.    7th 

Edition,  Revised  and  Enlarged.     164   Illustrations,  i   Plain   Plate, 
and  a  Zephyr  Test  Card.  J2.50 

From  The  Medical  Ketus. 

"  Swanzy  has  succeeded  in  producing  the  most  intellectually  con- 
ceived and  thoroughly  executed  resume  of  the  science  within  the 
limits  he  has  assigned  himself.  As  a  'students'  handbook,'  small 
in  size  and  of  moderate  price,  it  can  hardly  be  equaled." 

THORINGTON.    Retinoscopy.    4th  Edition.     Carefully  Revised. 
Illustrated.  Ji.oo 

THORINGTON.     Refraction  and  How  to  Refract.    200  Illustra- 
tions, 13  of  which  are  Colored.     2d  Edition.  $'.50 

WALKER.      Students'  Aid  in  Ophthalmology.     Colored  Plate 
and  40  other  Illustrations  and  Glossary.  $1.50 

WRIGHT.    Ophthalmology.    2d  Edition,  Revised  and  Enlarged. 
117  Illustrations  and  a  Glossary.  J3.00 


FEVERS. 

GOODALL  AND  WASHBOURN.    Fevers  and  Their  Treat- 
ment.    Illustrated.  fe.oo 

HEART. 

THORNE.     The  Schott  Methods  of  the  Treatment  of  Chronic 
Heart  Disease.    Fourth  Edition.    Illustrated,    /ust  Ready.    ^2.00 


HISTOLOGY. 

GUSHING.  Compend  of  Histology.  By  H.  H.  Gushing,  m.d.. 
Demonstrator  of  Histology,  Jefferson  Medical  College,  Philadelphia. 
Illustrated.    Nearly  Ready.  .80;  Interleaved,  Ji. 00 

STIRLING.  Outlines  of  Practical  Histology.  368  Illustrations. 
2d  Edition,  Revised  and  Enlarged.     With  new  Illustrations.       J2.00 

STOHR.  Histology  and  Microscopical  Anatomy.  Edited  by 
A.  SCHAPER,  M.D.,  University  of  Breslau,  formerly  Demonstrator  of 
Histology,  Harvard  Medical  School.  Fourth  American  from  9th  Ger- 
man Edition,  Revised  and  Enlarged.     379  Illustrations.  #3-oo 


MEDICAL  BOOKS. 


HYGIENE  AND  WATER  ANALYSIS. 

special  Catalogue  of  Books  on  Hygiene  sent  free  upon  application. 

CANFIELD.  Hygiene  of  the  Sick-Rootn.  A  Book  for  Nurses 
and  Others.  Being  a  Brief  Consideration  of  Asepsis,  Antisepsis,  Dis- 
infection, Bacteriology,  Immunity,  Heating,  Ventilation,  etc.       ^1.25 

CONN.     Agricultural  Bacteriology.     Illustrated.  ^2.50 

COPLIN.  Practical  Hygiene.  A  Complete  American  Text-Book. 
138  Illustrations.     New  Edition.  Preparing . 

HARTSHORNE.    Our  Homes.     Illustrated.  .40 

KENWOOD.  Public  Health  Laboratory  Work.  116  Illustra- 
tions and  3  Plates.  |2.oo 

LEFFMANN.  Select  Methods  in  Food  Analysis.  53  Illustra- 
tions and  4  Plates.  ^2.50 

LEFFMANN.  Examination  ot  Water  for  Sanitary  and 
Technical  Purposes.     4th  Edition.     Illustrated.  J'-^S 

LEFFMANN.  Analysis  oi  Milk  and  Milk  Products.  Illus- 
trated.    Second  Edition.  Ji-zS 

LINCOLN.    School  and  Industrial  Hygiene.  .40 

McFARLAND.  Prophylaxis  and  Personal  Hygiene.  Care  of 
the  Sick.     See  Cohen   Physiologic  Therapeutics, page  lb. 

NOTTER.  The  Theory  and  Practice  of  Hygiene.  15  Plates 
and  138  other  Illustrations.     8vo.     2d  Edition.  J7.00 

PARKES.  Hygiene  and  Public  Health.  By  Louis  C.  Parkes, 
M.D.     6th  Edition.     Enlarged.     Illustrated.  $3.00 

PARKES.  Popular  Hygiene.  The  Elements  of  Health.  A  Book 
for  Lay  Readers.     Illustrated.  fi-2S 

ROSENAU.    Disinfection  and  Disinfectants.    Illustrated.  J2.00 

STARR.  The  Hygiene  of  the  Nursery.  Including  the  General 
Regimen  and  Feeding  of  Infants  and  Children,  and  the  Domestic 
Management  of  the  Ordinary  Emergencies  of  Early  Life,  Massage, 
etc.     6th  Edition.     25  Illustrations.  Ji.oo 

STEVENSON  AND  MURPHY.  A  Treatise  on  Hygiene.  By 
Various   Authors.     In    Three    Octave    Volumes.     Illustrated. 

Vol.  I,  I6.00;  Vol.  II,  J6.00;  Vol.  Ill,  Js.oo 
*#*  Each  Volume  sold  separately.    Special  Circular  upon  application. 

THRESH.     Water  and  Water  Supplies.     3d  Edition.  J2.00 

WILSON.  Hand-Book  of  Hygiene  and  Sanitary  Science. 
With  Illustrations.     8th  Edition.  #3-oo 

\VEYL,  Sanitary  Relations  of  the  Coal-Tar  Colors.  Author- 
ized Translation  by  Henry  Leffmann,  m.d.,  ph.d.  Ji-^S 


LUNGS  AND  PLEUR.^. 

KNOPF.     Pulmonary  Tuberculosis.     Its   Modem  Prophylaxis 
and  Treatment  in  Special  Institutions  and  at  Home.     lUus.        I3.00 

STEELL.     Physical  Signs  of  Pulmonary  Disease.   Illus.   $1.25 


16  SUBJECT  CATALOGUK. 

MASSAGE— PHYSICAL  EXERCISE. 

OSTROM.  Massage  and  the  Original  Swedish  Move- 
ments. Their  Application  to  Various  Diseases  of  the  Body.  A 
Manual  for  Students,  Nurses,  and  Physicians.  Fifth  Edition,  En- 
larged.    IIS  Illustrations,  many  of  which  are  original.  $i.oo 

MITCHELL  AND  GULICK.  Mechanotherapy,  Physical 
Education,  etc.  Illustrated.  See  Cohen,  Physiologic  Therapeu- 
tics, below. 

TREVES.     Physical  Education.     Its  Value,  Methods,  etc.         .75 


MATERIA    MEDICA    AND     THERA- 
PEUTICS. 

BIDDLE.  Materia  Medica  and  Therapeutics.  Including  Dose 
List,  Dietary  for  the  Sick,  Table  of  Parasites,  and  Memoranda  of 
New  Remedies.  13th  Edition,  Revised.  64  Illustrations  and  a 
Clinical  Index.  Cloth,  J4.00;  Sheep,  J5. 00 

BRACKEN.    Outlines  of  Materia  Medica  and  Pharmacology.    J2.75 

COBLENTZ.  The  Newer  Remedies.  Including  their  Synonyms, 
Sources,  Methods  of  Preparation,  Tests,  Solubilities,  Doses,  etc. 
3d  Edition,  Enlarged  and  Revised.  ^i.oo 

COHEN.  Physiologic  Therapeutics.  Methods  other  than  Drug- 
Giving  useful  in  the  Prevention  of  Disease  and  m  the  Treatment  of 
the  Sick.  Mechanotherapy,  Mental  Therapeutics,  Suggestion, 
Electrotherapy,  Climatology,  Hydrotherapy,  Pneumatotherapy, 
Prophylaxis,  Dietetics,  Organotherapy,  Phototherapy,  Mineral 
Waters,  Baths,  etc.  11  Volumes,  Octavo.  Illustrated.  {Subscrip- 
tion^ Cloth,  IS27.50  ;  ^  mor.,  $38.50 
Special  Descriptive  Circular  "will  be  sent  tip  on  application. 

DAVIS.    Materia  Medica  and  Prescription  Writing.        J1.50 

GORQAS.  Dental  Medicine.  A  Manual  of  Materia  Medica  and 
Therapeutics.     7th  Edition,  Revised.  $4.00 

GROFF.  Materia  Medica  for  Nurses,  with  questions  for  Self  Exam- 
ination.    2d  Edition,  Revised  and  Improved.  In  Press. 

HELLER.  Essentials  of  Materia  Medica,  Pharmacy,  and 
Prescription  Writing.  gi.50 

MAYS.    Theine  in  the  Treatment  of  Neuralgia.     %  bound,  .50 

POTTER.  Hand-Book  of  Materia  Medica,  Pharmacy,  and 
Therapeutics,  including  the  Action  of  Medicines,  Special  Therapeu- 
tics, Pharmacology,  etc.,  including  over  600  Prescriptions  and  For- 
mulae, gth  Edition,  Revised  and  Enlarged.  With  Thumb  Index  in 
each  copy.    Just  Ready.  Cloth,  I5. 00;   Sheep,  J6. 00 

POTTER.  Compend  of  Materia  Medica,  Therapeutics,  and 
Prescription  Writing,  with  Special  Reference  to  the  Physiologi- 
cal Action  of  Drugs.     6th  Edition.  .80;  Interleaved,  gi. 00 

MURRAY.     Rough  Notes  on  Remedies.     4th  Edition.  J1.25 


MEDICAL  BOOKS.  17 


SAYRE.    Organic  Materia  Medica  and  Pharmacognosy.    Ad 

Introduction  to  the  Study  of  the  Vegetable  Kingdom  and  the  Vege- 
table and  Animal  Drugs.  Comprising  the  Botanical  and  Physical 
Characteristics.  Source,  Constituents,  and  Pharmacopeial  Prepara- 
tions, Insects  Injurious  to  Drugs,  and  Pharmacal  Botany.  With 
sections  on  Histology  and  Microtechnique,  by  W.  C.  Stevens. 
374  Illustrations,  many  of  which  are  original.    2d  Edition. 

Cloth,  J4.50 

TAVERA.     Medicinal  Plants  of  the  Philippines.  J2.00 

WHITE  AND  WILCOX.  Materia  Medica,  Pharmacy,  Phar- 
macology, and  Therapeutics.  5th  American  Edition,  Revised  by 
Reynold  W.  Wilcox,  m.a.,  m.d.,  ll.d.,  Professor  of  Clinical 
Medicine  and  Therapeutics  at  the  New  York  Post-Graduate  Medical 
School.  Cloth,  $3.00;  Leather,  J3. 50 

"  The  care  with  which  Dr.  Wilcox  has  performed  his  work  is  con- 
spicuous on  every  page,  and  it  is  evident  that  no  recent  drug  possess- 
ing any  merit  has  escaped  his  eye.  We  believe,  on  the  whole,  this  is 
the  best  book  on  Materia  Medica  and  Therapeutics  to  place  in  the 
hands  of  students,  and  the  practitioner  will  find  it  a  most  satisfactory 
work  for  daily  use." — The  Cleveland  Medical  Gazette. 

MEDICAL    JURISPRUDENCE     AND 
TOXICOLOGY. 

REESE.  Medical  Jurisprudence  and  Toxicology.  A  Text-Book 
for  Medical  and  Legal  Practitioners  and  Students.  5th  Edition. 
Revised  by  Henry  Lepfmann,  m.d.       Clo.,  J3.00 ;  Leather,  ^3.50 

"  To  the  student  of  medical  jurisprudence  and  toxicology  it  is  in- 
valuable, as  it  is  concise,  clear,  and  thorough  in  every  respect." — The 
American  Journal  of  the  Medical  Sciences. 

MANN.    Forensic  Medicine  and  Toxicology.     lUus.  $6.50 

TANNER.  Memoranda  of  Poisons.  Their  Antidotes  and  Tests. 
8th  Edition,  by  Dr.  Henry  Leffmann.  .75 


MICROSCOPY. 

CARPENTER.     The  Microscope  and    Its    Revelations.    8th 

Edition,  Revised  and  Enlarged        817  Illustrations  and   23    Plates. 
Cloth,  fS.oo  ;  Half  Morocco,  ^.00 

LEE.  The  Microtomist's  Vade  Mecum.  A  Hand-Book  oi 
Methods  of  Microscopical  Anatomy.  887  Articles.  5th  Edition, 
Enlarged.  |!4.oo 

OERTEL.  Medical  Microscopy.  A  Guide  to  Diagnosis,  Ele- 
mentary Laboratory  Methods  and  Microscopic  Technic.  120  Illus- 
trations. Nearly  Ready. 

REEVES.  Medical  Microscopy,  including  Chapters  on  Bacteri- 
ology, Neoplasms,  Urinary  Examination,  etc.  Numerous  Illus- 
trations, some  of  which  are  printed  in  colors.  J2.50 

WETHERED.  Medical  Microscopy.  A  Guide  to  the  Use  of  the 
Microscope  in  Practical  Medicine.     100  Illustrations.  $2.00 


SUBJECT  CATALOGUE. 


MISCELLANEOUS. 

BERRY,     Diseases  of  Thyroid  Gland.     Illustrated.  I4.00 

BURNETT.     Foods  and  Dietaries.     A  Manual  of  Clinical  Diet- 
etics.    2d  Edition.  $i-50 
BUXTON.     Anesthetics.     Illustrated.     3d  Edition.                   $1.50 

COHEN.  Organotherapy.  See  Cohen,  Physiologic  Therapeutii-s, 
page  lb. 

DAVIS.  Dietotherapy.  Food  in  Health  and  Disease.  With 
Tables  of  Dietaries,  Relative  Value  of  Foods,  etc.  See  Cohen, 
Physiologic  Therapeutics ,  page  lb. 

FRENKEL.     Tabetic  Alaxia.    Just  Ready.  1^3.00 

GOULD.  Borderland  Studies.  Miscellaneous  Addresses  and 
Essays.     i2mo.  $2.00 

GREENE.  Medical  Examination  for  Life  Insurance.  Illus- 
trated.    With  Colored  and  other  Engravings.  J4.00 

HAIG.  Causation  of  Disease  by  Uric  Acid.  The  Pathology  of 
High  Arterial  Tension,  Headache,  Epilepsy,  Gout,  Rheumatism, 
Diabetes,  Bright's  Disease,  etc.     5th Edition.  t3-°° 

HAIG.  Diet  and  Food.  Considered  in  Relation  to  Strength  and 
Powrer  of  Endurance.     4th  Edition.  Ji.oo 

HENRY.    A  Practical  Treatise  on  Anemia.  Half  Cloth,  .50 

LEFFMANN.     Food  Analysis.     Illustrated.  ^2.50 

NEW  SYDENHAM  SOCIETY'S  PUBLICATIONS.  Circulars 
upon  application.  Per  Annum,  J8.00 

OSGOOD.    The  Winter  and  Its  Dangers.  .40 

PACKARD.     Sea  Air  and  Sea  Bathing.  .40 

RICHARDSON.     Long  Life  and  How  to  Reach  It.  .40 

TISSIER.     Pneumatotherapy.    See  Cohen,  Physiologic  Therapeu- 
tics, page  lb. 
TURNBULL.    Artificial  Anesthesia,     ^th  Edition.    lUus.    $2.50 
WEBER     AND     HINSDALE.        Climatology    and     Health 
Resorts.      Including   Mineral   Springs.     2   Vols.     Illus  rated   with 
Colored  Maps.     See  Cohen,  Physiologic  Therapeutics ,  page  lb. 
WILSON.    The  Summer  and  Its  Diseases.  .40 

WINTERNITZ.  Hydrotherapy,  Thermotherapy,  Photo- 
therapy, Mineral  Waters,  Baths,  etc.    Illustrated.    See  Cohen, 

Physiologic  Therapeutics ,  page  lb. 


NERVOUS  DISEASES. 

DERCUM.  Rest,  Suggestion,  Mental  Therapeutics.  See 
Cohen,  Physiologic  Therapeutics, page  ib. 

GORDINIER.  The  Gross  and  Minute  Anatomy  of  the  Cen- 
tral Nervous  System.  With  271  original  Colored  and  other 
Illustrations.  Cloth,  $6.00;  Sheep,  $7.00 

GOWERS.    Syphilis  and  the  Nervous  System.  ^i.oo 


MEDICAL  BOOKS.  19 


GOWERS.    Manual  of  Diseases  of  the  Nervous  System.    A 
Complete  Text-Book.     Revised,  Enlarged,  and  in  many  parts  Re- 
written.    With  many  new  Illustrations.     Two  volumes. 
Vol.  I.   Diseases  of  the  Nerves  and  Spinal  Cord.     3d  Edition    En- 

Tr'f  ^t't^- T^-  ,     ^    „  Cloth,  J4.00;  Sheep,  ^5.00 

Vol.  II.    Diseases  of    the  Brain  and  Cranial  Nerves ;    General  and 

Functional  Disease.    2d  Edition.  Cloth,  J4.00;  Sheep,  I5.00 

°°j^?^^*  Epilepsy  and  Other  Chronic  Convulsive  Diseases. 

2d  Edition.  *3.oo 

HORSLEY,    The   Brain   and  Spinal  Cord.    The  Structure  and 

functions  of.    Numerous  Illustrations.  ^2.50 

ORMEROD.  Diseases  of  the  Nervous  System.  66  Wood  En- 
gravings.  j^  <^ 

PERSHING.  Diagnosis  of  Nervous  and  Mental  Diseases 
Illustrated.  <j  2, 

PRESTON.    Hysteria  and  Certain  Allied  Conditions.    Their 

Nature  and  Treatment.    Illustrated.  J2.00 

WOOD.    Brain  Work  and  Overwork.  .40 

NURSING  (see  also  Massage). 

Sj^ecial  Catalogue  of  Books  for  Nurses  sent  free  upon  application. 

CANFIELD.  Hygiene  of  the  Sick-Room.  A  Book  for  Nurses  and 
Uthe^.  Being  a  Brief  Consideration  of  Asepsis,  Antisepsis,  Disinfec- 
tion, Bacteriology,  Immunity,  Heating  and  Ventilation,  and  Kindred 
bubjects  for  the  Use  of  Nurses  and  Other  Intelligent  Women.    ^1.25 

CUFF.     Lectures  to  Nurses  on  Medicine.    Third  Edition.    J1.25 

^^y^^-  .Bandaging.  Its  Principles  and  Practice.  165  Original 
Illustrations,     fust  Ready.  |i 

DOMVILLE.  Manual  for  Nurses  and  Others  Engaged  in  At- 
tending the  Sick.  9th  Edition.  With  Recipes  for  Sick-room  Cook- 
«'T^''="=-  In  Press. 

FULLERTON.    Obstetric  Nursing.    41  Ills.    5th  Ed.  Ji.oo 

FULLERTON.     Surgical    Nursing.    3d  Ed.    69  Ills.  |i.oo 

GROFF.  Materia  Medica  for  Nurses.  With  Questions  for  Self-Ex- 
amination.     2d  Edition,  Revised  and  Improved,   fust  Ready,    gi.25 

HADLEY  General,  Medical,  and  Surgical  Nursing.  A  very 
Complete  JVIanual,  Including  Sick- Room  Cookery,  fust  Ready.  |i  25 

HUMPHREY.  A  Manual  for  Nurses.  Including  General 
Anatomy  and  Physiology,  Management  of  the  Sick  Room,  etc. 
23d  Edition.     79  Illustrations.  ^i.oo 

STARR.  The  Hygiene  of  the  Nursery.  Including  the  General 
Kegimen  and  Feeding  of  Infants  and  Children,  and  the  Domestic  Man- 
agement of  the  Ordinary  Emergencies  of  Early  Life,  Massage,  etc.  6th 
Edition.     25  Illustrations.  ji  00 

TEMPERATURE  AND  CLINICAL  CHARTS.     See  page  24. 

VOSWINKEL.  Surgical  Nursing.  Second  Edition,  Enlarged, 
iia  Illustrations.  '  £,  ^ 


20  SUBJECT   CATALOGUE. 

OBSTETRICS. 

CAZEAUX  AND  TARNIER.  Midwifery.  With  Appendix  by 
MundA.  The  Theory  and  Practice  of  Obstetrics,  including  the  Dis- 
eases of  Pregnancy  and  Parturition,  Obstetrical  Operations,  etc. 
8th  Edition.  Illustrated  by  Colored  and  other  full-page  Plates,  and 
numerous  Wood  Engravings.  Cloth,  $4.50  ;  Full  Leather,  J5.50 

EDGAR.  Text-Book  of  Obstetrics.  By  J.  Clifton  Edgar, 
M.D.,  Professor  of  Obstetrics,  Medical  Department  of  Cornell 
University,  New  York  City.     Elaborately  Illustrated.  In  Press. 

FULLERTON.    Obstetric  Nursing.     5th  Ed.    Illustrated.    $1.00 

LANDIS.  Compend  of  Obstetrics.  7th  Edition,  Revised  by  Wm. 
H.  Wells,  Demonstrator  ot  Clinical  Obstetrics,  Jefferson  Medical 
College.     52  Illustrations.  .80  ;  Interleaved,  Ji.oo 

WINCKEL.  Text-Book  of  Obstetrics,  Including  the  Pathol- 
ogy and  Therapeutics  of  the  Puerperal  State.    lUus.    Js.oo 

PATHOLOGY— BACTERIOLOGY. 

BLACK.     Micro-Organisms.     The  Formation  of  Poisons.  .75 

BLACKBURN.    Autopsies.    A  Manual  of  Autopsies  Designed  for 

the  Use  ot  Hospitals  for  the  Insane  and  other  Public  Institutions. 

Ten  full-page  Plates  and  other  Illustrations.  ^1.25 

CONN.    Agricultural  Bacteriology.     Illustrated.  ^2.50 

CONN.     Bacteria  in  Milk  Products.     Illustrated.  In  Press. 

COPLIN.  Manual  of  Pathology.  Including  Bacteriology,  Technic 

of  Post-Mortems,  Methods  of  Pathologic  Research,  etc.     330  Illus- 
-    trations,  7  Colored  Plates.     3d  Edition.  f3-5o 

DA  COSTA.     Clinical  Hematology.     A  Practical  Guide   to  the 

Examination  of  the  Blood.     Six  Colored  Plates  and  48  Illustrations. 

fust  Ready.  Cloth,  J5. 00;  Sheep,  J6. 00 

EMERY.     Bacteriological  Diagnosis.     2  Colored  Plates  and  32 

other  Illustrations.    Just  Ready.  Ji-so 

HEWLETT.     Manual  of  Bacteriology.   75  Illustrations.    Second 

Edition,  Revised  and  Enlarged.    Just  Ready.  J4.00 

LAZERUS-BARLOW.  Pathological  Anatomy.  Nearly  Ready. 
ROBERTS.   Gynecological  Pathology.   Illustrated.  $6.00 

SMITH.     Laboratory  Exercises  in  Bacteriology.     Illustrated. 

Just  Ready.  |i-50 

THAYER.        Compend    of    General    Pathology.       Illustrated. 
Just  Ready.     .80;  Interleaved,  Ji.co 
THAYER.     Compend  of  Special  Pathology.     Illustrated. 

Just  Ready.  .80;  Interleaved,  Ji.oo 
VIRCHOW.  Post-Mortem  Examinations,  3d  Edition.  .75 
WHITACRE.     Laboratory  Text-Book   of   Pathology.     With 

121  Illustrations.  Si-5° 

WILLIAMS.  Bacteriology.  A  Manual  for  Students.  90  Illus- 
trations,    zd  Edition,  Revised.  ?i-5o 

PHARMACY. 

special  Catalogue  of  Books  on  Pharmacy  sent  free  upon  application. 

COBLENTZ.  Manual  of  Pharmacy.  A  Complete  Text-Book 
by  the  Professor  in  the  New  York  College  of  Pharmacy,  ad  Edition, 
Revised  and  Enlarged.  437  lUus.  Cloth,  J3. 50;  Sheep,  J4. 50 

COBLENTZ.    Volumetric  Analysis.     Illustrated.  ^1-25 


MEDICAL   BOOKS.  21 


BEASLEY.  Book  of  3100  Prescriptions,  Collected  from  the 
Practice  of  the  Most  Eminent  Physicians  and  Surgeons— English 
Jrench,  and  American.  A  Compendious  History  of  the  Materia 
Medica,  Lists  of  the  Doses  of  all  the  Officinal  and  EsUblished  Pre- 
parations, an  iKdex  of  Diseases  and  their  Remedies.     7th  Ed.     |2.oo 

BEASLEY.  Druggists'  General  Receipt  Book.  Comprising 
a  Copious  Veterinary  Formulary,  Recipes  in  Patent  and  Proprietary 
Medicines,  Druggists'  Nostrums,  etc. ;  Perfumery  and  Cosmetics 
Beverages  Dietetic  Articles  and  Condiments,  Trade  Chemicals 
Scientific  Processes,  and  many  Useful  Tables.     loth  Ed.  ^2.00 

BEASLEY.  Pharmaceutical  Formulary.  A  Synopsis  of  the 
British,  f  rench,  German,  and  United  States  Pharmacopoeias.  Com- 
prising Standard  and  Approved  Formulae  for  the  Preparations  and 
Compounds  Employed  in  Medicine.     12th  Edition.  J2.00 

^^'^StT^^'  .  ^'^'u^'*^*!  Pl'a'-macy.  3d  Edition,  with  Illustrations 
and  Elaborate  Tables  o(  Chemical  Solubilities,  etc.  ^3.00 

^°^^p??°^-«.^?",".^''®"''""  °f  Pharmacy  and  Medicine. 

3d  Edition.     With  elaborate  Vocabularies.  ji.75 

^^X^?'    P^S^aic  Materia  Medica  and  Pharmacognosy,    An 

Introduction  to  the  Study  of  the  Vegetable  Kinedom  and  the  Vege- 
table and  Animal  Drugs.  Comprising  the  Botanical  and  Physical 
Characteristics,  Source,  Constituents,  and  Pharmacopeial  Prepar- 
ations, Insects  Injurious  to  Drugs,  and  Parmacal  Botany.  With 
sections  on  Histology  and  Microtechnique,  by  W.  C  Stevens 
374  Illustrations.    Second  Edition.  Cloth,  14.50 

SCOVILLE.  The  Art  of  Compounding.  Second  Edition,  Re- 
vised and  Enlarged.  "  Cloth,  J2.S0 

^T.^^x^Tp  9°"}^^^^  °'  Pharmacy.  Based  upon  "  Reming- 
ton s  lext-Book  of  Pharmacy."  5th  Edition,  Revised  in  Accord- 
ance  with  the  U  S  Pharmacopoeia,  1890.  Complete  Tables  ot 
Metric  and  English  Weights  and  Measures.     .80 ;    Interleaved,  Ji.oo 

TAVERA.    Medicinal  Plants  of  the  Philippines.  '  «2  00 

"r/o"!if  ^  STATES  PHARMACOPCEIA.  7th  Decennial  Revision. 
Cloth  $2.50  (postpaid  I2.77);  Sheep,  J3.00  (postpaid,  ^3.27)  ;  Inter- 
leaved, ^4  00  (postpaid.  I4.50);  Printed  on  one  side  of  page  only 
unbound,  ^3.50  (postpaid,  I3.90).  '^  ^         ^' 

Select  Tables  from  the  U.  S,  P.     Being  Nine  of  the  Most  Impor- 
tant  and  Useful  Tables,  Printed  on  Separate  Sheets.  .25 

POTTER.  Hand-Book  of  Materia  Medica,  Pharmacy,  and 
Therapeutics.    600  Prescriptions.    8th  Ed.    Clo.,  I5.00  ;  Sh  ,  |6.oo 

PHYSIOLOGY. 

^efmustratTo"'""'    Physiology.     An  Elementary  Class  B^ook. 

^fn^  Wni^^^"  ^.'""Pen^  of  Physiology,  nth  Edition,  Revised 
and  Enlarged.     Illustrated.    y«.s-^  ^^^^_y.  80;  Interleaved,  Ji  00 

JONES.    Outlines  of  Physiology.    96  Illustrations.  ji.50 

^rI!^.^?"  R"*"'^t.°°k  of  Physiology.  17th  Authorized  Edition. 
TOTof'K^n"?-"!!"^'  ""f  E"larged.  By  Prof.  W.  D.  Hallieur: 
TON.  ot  Kings  College,  London.  681  Illustrations,  some  of  which 
are  in  colors.  Cloth.  J3.00 ;  Leather  I3.75 


22  SUBJECT  CATALOGUE. 

LANDOIS.  A  Text-Book  of  Human  Physiology,  Including 
Histology  and  Microscopical  Anatomy,  with  Special  Reference  to 
the  Requirements  of  Practical  Medicine.  5th  American,  translated 
from  the  last  German  Edition,  with  Additions  by  Wm.  Stirling, 
M.D.jD.sc.    845  Illus.,  many  of  which  are  printed  in  colors.    Jn  Press. 

STARLING.     Elements  of  Human  Physiology.     100  Ills.    $1.00 

STIRLING.  Outlines  of  Practical  Physiology.  Including 
Chemical  and  Experimental  Physiology,  with  Special  Reference  to 
Practical  Medicine.     3d  Edition.     289  Illustrations.  $2.00 

TYSON.     Cell  Doctrine.    Its  History  and  Present  State.        $1.50 

PRACTICE. 

BEALE.    On  Slight  Ailments;  their  Nature  and  Treatment. 

2d  Edition,  Enlarged  and  Illustrated.  Ji-^S 

FAGGE.     Practice  of  Medicine.      4th    Edition,  by  P.   H.    Pye- 
Smith,  M  D.     2  Volumes,    fust  Ready.    Vol.  I, ^6. 00;  Vol.  II,  $6.00 
FO'WLER.      Dictionary  of   Practical    Medicine.      By  various 
writers.  An  Encyclopsedia  of  Medicine.  Clo.,$3.oo;  Half  Mor.  $4.00 
GOULD  AND  PYLE.     Cyclopedia  of  Practical  Medicine  and 
Surgery.     A  Concise  Reference  Handbook,  with  particular  Refer- 
ence  to  Diagnosis  and   Treatment      Edited   by    Drs    Gould    and 
Pyle,  Assisted  by  72  Special  Contributors.     Illustrated,  one  volume. 
Large  Square  Octavo,  Uniform  with  "Gould's  Illustrated  Diction- 
ary." Sheep  or  Half  Mor.,  |io.oo  ;  with  Thumb  Index,  Jii.oo 
Half  Russia,  Thumb  Index,  J12  00 
J}^  Complete  descriptive  circular  free  upon  application. 
GOULD  AND  PYLE'S  Pocket  Cyclopedia  of  Medicine  and 
Surgery.     Based   upon   the   above   and    Uniform   with   "  Gould's 
Pocket  Dictionary."  Full  Limp  Leather,  Gilt  Edges,  Round  Corners, 
Ji.oo.     With  Thumb  Index,  $1.25 
HUGHES.    Compend  of  the  Practice  of  Medicine.    6th  Edition, 
Revised  and  Enlarged. 

Part  I.     Continued,  Eruptive,  and  Periodical  Fevers,  Diseases  of  the 
Stomach,   Intestines,  Peritoneum,  Biliary   Passages,  Liver,  Kid- 
neys, etc.,  and  General  Diseases,  etc. 
Part  II.     Diseases  of  the  Respiratory  System,  Circulatory  System, 
and  Nervous  System;  Diseases  of  the  Blood,  etc. 

Price  of  each  part,  .80;  Interleaved,  Ji.oo 
Physician's   Edition.     In  one  volume,  including  the  above  two 
parts,  a   Section  on  Skin   Diseases,  and  an  Index.     6th  Revised 
Edition.     625  pp.  Full  Morocco,  Gilt  Edge,  I2.25 

MURRAY.    Rough  Notes  on  Remedies.    4th  Ed.  ^1.25 

TAYLOR.     Practice  of  Medicine.    6th  Edition.  J4.00 

TYSON.  The  Practice  of  Medicine.  By  James  Tyson,  m.d.. 
Professor  of  Medicine  in  the  University  of  Pennsylvania.  A  Com- 
plete Systematic  Text-book  with  Special  Reference  to  Diagnosis  and 
Treatment.  2d  Edition,  Enlarged  and  Revised.  Colored  Plates  and 
125  other  Illustrations.     1222  Pages.       Cloth,  ^5.50;  Leather,  ^6.50 

STOMACH.     INTESTINES. 

FEN  WICK.     Cancer  of  the  Stomach.  In  Press. 

HEMMETER.  Diseases  of  the  Stomach.  Their  Special  Path- 
ology, Diagnosis,  and  Treatment.  With  Sections  on  Anatomy, 
Analysis  of  Stomach  Contents,  Dietetics,  Surgery  of  the  Stomach, 
etc.  3d  Edition,  Revised.  With  15  Plates  and  41  other  Illustrations, 
a  number  of  which  are  in  Colors.    Just  Ready. 

Cloth,  J6.00;  Sheep,  J7.00 


MEDICAL  BOOKS.  23 


HEMMETER.  Diseases  of  the  Intestines.  Their  Special  Path- 
ology, Diagnosis,  and  Treatment.  With  Sections  on  Anatomy  and 
Physiology,  Microscopic  and  Chemic  Examination  of  Intestinal 
Contents,  Secretions,  Feces  and  Urine,  Intestinal  Bacteria  and 
Parasites,  Surgery  of  the  Intestines,  Dietetics,  Diseases  of  the 
Rectum,  etc.  With  Full-page  Colored  Plates  and  many  other 
Original  Illustrations.     2  Volumes.     Octavo.    Just  Ready. 

Price  of  each  Volume,  Cloth,  ^S. 00;   Sheep,  J6.00 

SKIN. 

BULKLEY.    The  Skin  in  Health  and  Disease.    Illustrated.    .40 

CROCKER.  Diseases  of  the  Skin.  Their  Description,  Pathol- 
ogy, Diagnosis,  and  Treatment,  with  Special  Reference  to  the  Skin 
Eruptions  of  Children.  3d  Edition,  Thoroughly  Revised.  With 
New  Illustrations.  Nearly  Ready.    $5.00 

SCHAMBERG.  Diseases  of  the  Skin.  2d  Edition,  Revised  and 
Enlarged.    105  Illustrations.    Being  No.  16  ?  Quiz-Compend  T  Series. 

Cloth,  .80;  Interleaved,  |i. 00 

VAN  HARLINGEN.  On  Skin  Diseases.  A  Practical  Manual 
of  Diagnosis  and  Treatment,  with  special  reference  to  Differential 
Diagnosis.  3d  Edition,  Revised  and  Enlarged.  With  Formulae 
and  60  Illustrations,  some  of  which  are  printed  in  colors.        $2-75 

SURGERY  AND  SURGICAL  DIS- 
EASES (see  also  Urinary  Organs). 

BERRY.  Diseases  of  the  Thyroid  Gland  and  Their  Surgical 
Treatment.     Illustrated.  J4.00 

BUTLIN.  Operative  Surgery  of  Malignant  Disease.  2d  Edi- 
tion.    Illustrated.     Octavo.  ^4-50 

DAVIS.  Bandaging.  Its  Principles  and  Practice.  163  Origina 
Illustrations.  «i  50 

DEAVER.  Surgical  Anatomy.  A  Treatise  on  Human  Anatomy 
in  its  Application  to  Medicine  and  Surgery.  With  about  450  very 
Handsome  full-page  Illustrations  Engraved  from  Original  Drawings 
made  by  special  Artists  from  Dissections  prepared  for  the  purpose. 
Three  Volumes.     Royal  Square  Octavo. 

Cloth,  J21. 00;  Half  Morocco  or  Sheep,  $24.00  ;  Half  Russia,  $27.00 
Cotnplete  descriptive  circular  and  special  terms  upon  application. 

DEAVER.  Appendicitis,  Its  Symptoms,  Diagnosis,  Pathol- 
ogy, Treatment,  and  Complications.  Elaborately  Illustrated 
with  Colored  Plates  and  other  Illustrations.    3d  Edition.   Preparing . 

DULLES.  What  to  Do  First  in  Accidents  and  Poisoning. 
5th  Edition.     New  Illustrations.  |i.oo 

FULLERTON.     Surgical  Nursing.     3d  Edition.    69  Illus.    $1.00 

HAMILTON.     Lectures  on  Tumors.     3d  Edition.  $1.25 

HEATH.  Minor  Surgery  and  Bandaging  12th  Edition,  Revised 
and  Enlarged.     195  Illus.,  Formula;,  Diet  List,  etc.  I1.50 

HEATH.  Clinical  Lectures  on  Surgical  Subjects.  Second 
Series.    Just  Ready.  I2.00 

HORWITZ.  Compend  of  Surgery  and  Bandaging,  including 
Minor  Surgery,  Amputations,  Fractures,  Dislocations,  Surgical  Dis- 
eases, etc.,  with  Differential  Diagnosis  and  Treatment.  5th  Edition, 
very  much  Enlarged  and  Rearranged.    167  Illustrations,  q8  Formulae. 

Cloth,  .80  ;  Interleaved,  Ji. 00 


24  SUBJECT  CATALOGUE. 

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550  Illustrations.     Two  Volumes.  Cloth,  Jto.oo;   Leather,  ]|i2.oo 

KEAY.  Medical  Treatment  of  Gall  Stones.  Just  Ready,  ti.i'i 
KEHR.    Gail-Stone  Disease.    Translated  by  William  Wotkyns 

Seymour,  m.d.  I2S0 

MAKINS.     Surgical  Experiences  in  South  Africa.     1899-1900. 

Illustrated.  $4.00 

MAYLARD.    Surgery  of  the  Alimentary  Canal.   97  Illustrations. 

2d  Edition,  Revised.  f3-oo 

MOULLIN.  Text-Book  of  Surgery.  With  Special  Reference  to 
Treatnient.  3d  American  Edition.  Revised  and  edited  by  John  B. 
Hamilton,  m.d.,  ll.d..  Professor  of  the  Principles  of  Surgery  and 
Clinical  Surgery,  Rush  Medical  College,  Chicago.  623  Illustrations, 
many  of  which  are  printed  in  colors.     Cloth,  JS6.00;   Leather,  J7.00 

SMITH.  Abdominal  Surgery.  Being  a  Systematic  Description  of 
all  the  Principal  Operations.    224  Illus.  6th  Ed.    2  Vols.  Clo.,  ^10.00 

VOSW^INKEL.  Surgical  Nursing.  Second  Edition,  Revised  and 
Enlarged,     in  Illustrations.  Ji.oo 

WALSHAM.  Manual  of  Practical  Surgery.  7th  Ed.,  Re- 
vised and  Enlarged.   483  Engravings.   950  pages.  %'i-ffi 


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HOLLOPETER.     Hay  Fever.     Its  Successful  Treatment.      Ji.oo 
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McBRIDE.   Diseases  of  the  Throat,  Nose,  and  Ear.    With  col- 
ored Illustrations  from  original  drawings.   3d  Edition.  f7-oo 
POTTER.     Speech  and  its  Defects.    Considered  Physiologically, 
Pathologically,  and  Remedially.                                                        ^i.oo 


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GOWERS.     Syphilis  and  the  Nervous  System.  $1.00 

STURGIS   AND   CABOT.      Student's    Manual    of   Venereal 

Diseases.     7th  Revised  and  Enlarged  Ed      i2mo.  ?i.2s 


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BALLOU.    Veterinary  Anatomy  and  Physiology.    29  Graphic 
Illustrations.  .80;  Interleaved,  Ji. 00 


WOMEN,  DISEASES  OF. 

BISHOP.     Uterine  Fibromyomata.   Their  Pathology,  Diagnosis, 
and  Treatment.     Illustrated.  Cloth   S3. 50 

BYFORD    (H.   T.).     Manual   of    Gynecology.     Third    Edition, 
Revised  and  Enlarged.     363  Illustrations,     fust  Ready.  J3.00 

DUHRSSEN.     A  Manual    of   Gynecological    Practice.      105 
Illustrations.  ti.50 

FULLERTON.     Surgical   Nursing.     3d   Edition,   Revised  and 
Enlarged.     69  Illustrations.  Si.oo 

LEWERS.    Diseases  of  Women.    146  Illus.    sth  Ed.  ^2.50 

MONTGOMERY.      Practical    Gynecology.     A   Complete   Sys- 
tematic Text-Book.    527  Illustrations.     Cloth,  J5.00;  Leather,  ;^6. 00 

ROBERTS.      Gynecological    Pathology,      With   127   Full-page 
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WELLS.     Compend  of  Gynecology.     Illustrated.     2d  Edition. 

.  80  ;  Interleaved,  %i  .00 


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could  be  found  for  either  student  or  practitioner." — Southern  Clinic. 


BLAKISTON'S  ?QUIZ-COMPENDS? 

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Price  of  each,  Cloth,  .80.         Interleaved,  for  taking  Notes,  $1.00. 

These  Compends  are  based  on  the  most  popular  text-books  and 
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subjects  upon  which  they  treat  The  authors  have  had  large  experi- 
ence as  Quiz-Masters  and  attaches  of  colleges,  and  are  well  acquainted 
with  the  wants  of  students.  They  are  arranged  in  the  most  ap- 
proved form,  thorough  anci  concise,  containing  nearly  looo  illustra- 
tions and  lithograph  plates,  inserted  wherever  they  could  be  used  to 
advantage.  Can  be  used  by  students  of  any  college.  They  contain 
information  nowhere  else  collected  in  such  a  condensed,  practical  shape. 

No.  X.  POTTER.  HUMAN  ANATOMY.  Sixth  Edition.  117 
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Edition,  Enlarged  and  Improved. 

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Sixth  Edition,  Revised  and  Improved. 

No.  4.    BRUBAKER.  PHYSIOLOGY.  Eleventh  Edition.  Illus. 

No.  5.  LANDIS.     OBSTETRICS.     Seventh  Edition.      52  Illus. 

No.  6.  POTTER.  MATERIA  MEDICA,  THERAPEUTICS, 
AND  PRESCRIPTION  WRITING.    Sixth  Revised  Edition. 

No.  7.   WELLS.     GYNECOLOGY.     Second   Ed.     140  Illus. 

No.  8.  GOULD  AND  PYLE.  DISEASES  OF  THE  EYE, 
Second  Edition.    Refraction,  Treatment,  Surgery,  etc.    109  Illus. 

No.  9.  HORWITZ.  SURGERY.  Including  Minor  Surgery, 
Bandaging,  Surgical  Diseases,  Differential  Diagnosis  and  Treat- 
ment.   Fifth  Edition.    With  98  Formulae  and  71  Illustrations. 

No.  10.  LEFFMANN.  MEDICAL  CHEMISTRY.  Fourth 
Edition.  Including  Urinalysis,  Animal  Chemistry,  Chemistry  ol 
Milk,  Blood,  Tissues,  the  Secretions,  etc. 

No.  II.  STEWART.  PHARMACY.  Fifth  Edition.  Based  upon 
Prof.  Remington's  Text-Book  of  Pharmacy. 

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SIOLOGY.    29  graphic  Illustrations. 

No.  13.  WARREN.  DENTAL  PATHOLOGY  AND  DEN- 
TAL MEDICINE.     Third  Edition,  Illustrated. 

No,  14.  HATFIELD.      DISEASES  OF   CHILDREN.    3d  Ed. 

No.  15.  THAYER.     GENERAL  PATHOLOGY.     78  Illus. 

No.  16.  SCHAMBERG.  DISEASES  OF  THE  SKIN.  Second 
Edition,  Revised  and  Enlarged.     105  Illustrations. 

No.  17.  CUSHING.     HISTOLOGY.     Illustrated. 

No.  18.  THAYER.  SPECIAL  PATHOLOGY.  34  Illustrations. 
Careful  attention  has  been  given  to  the  construction  of  each  sentence, 

and  while  the  books  will  be  found  to  contain  an  immense  amount  of 

knowledge  in  small  space,  they  will  likewise  be  found  easy  reading 
26 


DA   COSTA 


Clinical   Hematology 


A  Practical  Guide  to  the  Examination  of  the  Blood  by 
Clinical  Methods.  With  Reference  to  the  Diagnosis  of 
Disease.     With  Colored  Illustrations.  Cloth,  ^5.00 

*^*  A  new,  thorough,  systematic,  and  comprehensive 
work,  its  purpose  being,  first,  to  show  how  to  examine  the 
blood,  and  second,  how  to  diagnose  from  such  examination 
diseases  of  the  blood  itself  and  general  diseases.  The 
author's  aim  has  been  to  cover  not  alone  the  field  of  original 
research,  but  to  supply  a  book  for  the  student,  the  hospital 
physician  and  the  general  practitioner.  It  will  be  found 
wanting  in  none  of  these  respects. 

OERTEL 


Medical   Microscopy 

NEARLY  READY 

A  GUIDE  TO  DIAGNOSIS,  ELEMEN- 
TARY LABORATORY  METHODS, 
AND     MICROSCOPIC    TECHNIC 

By  T.  E.   Oertel,  M.D., 

Professor  of  Pathology  and   Clinical   Microscopy,  Medical   Depart- 
ment, University  of  Georgia. 

WITH   120  ILLUSTRATIONS 

27 


JACOBSON'S 
Operations  of  Surgery 


The  Operations  of  Surgery.  By  W.  H.  A. 
Jacobson,  F.R.C.S.,  Surgeon  to  Guy's  Hospital; 
Consulting  Surgeon  Royal  Hospital  for  Children 
and  Women;  Member  Court  of  Examiners  Ro3^al 
College  of  Surgeons;  Joint  Editor  Annals  of  Sur- 
gery; and  F.  J.  Steward,  f.r.c.s.,  Assistant 
Surgeon  Guy's  Hospital  and  to  the  Hospital  for 
Sick  Children.  Fourth  Edition,  Revised,  En- 
larged and  Improved.  550  Illustrations.  Two 
Volumes,   Octavo,    1524  pages.        Cloth,  $10.00 

Sheep,  $12.00 

PJRESS  NOTICES  OF  FORMER  EDITIONS 

"  The  author  proves  himself  a  judicious  operator,  as 
shown  by  his  choice  of  methods  and  by  the  emphasis  with 
which  he  refers  to  the  different  dangers  and  comphcations 
which  may  arise  to  mar  success  or  jeopardize  Hfe." — A^ein 
York  Medical  Record. 

"  The  important  anatomical  points  are  clearly  set  forth, 
the  conditions,  indicating  or  contraindicaling  operative  inter- 
ference are  given,  the  details  of  the  operations  themselves 
are  brought  forward  prominently,  and  frequently  the  after- 
treatment  is  considered.  Herein  is  one  of  the  strong  points 
of  the  book." — A^ew  York  Medical JottniaL 
28 


The  Pocket  Cyclopedia  of 
Medicine   and   Surgery 

Full  Limp  Leather,  Round  Corners,  Gill  Edges,  $1.00 
With  Thumb  Index,  $1.25 

Uniform  -with  "Gould's  Pocket  Dictionary" 


A  concise  practical  volume  of  nearly  600 
pages,  containing  a  vast  amount  of  infor- 
mation on  all  medical  subjects,  including 
Diagnosis  and  Treatment  of  Disease, 
with  Formulas  and  Prescriptions,  Emer- 
gencies, Poisons,  Drugs  and  Their  Uses, 
Nursing,  Surgical  Procedures,  Dose  List 
in  both  English  and  Metric  Systems,  etc. 

By  Drs.  Gould  and  Pyle 

Based  upon  their  large  '*  Cyclopedia  of 
Medicine  and  Surgery,"      ,^       ^       ^ 


*^*  This  is  a  new  book  which  will  prove  of  the  greatest 
value  to  students.  It  is  to  the  broad  field  of  general  medi- 
cal information  what  "Gould's  Pocket  Dictionary"  is  to 
the  more  special  one  of  definition  and  pronunciation  of 
words.  The  articles  are  concise  but  thorough,  and  arranged 
in  shape  for  quick  reference.  In  no  other  book  can  be 
found  so  much  exact  detailed  knowledge  so  conveniently 
classified,  so  evenly  distributed,  so  methodically  grouped. 
It  is  Multum  itt  Parvo. 

29 


A  NEW  EDITION 


Crocker  on  the  Skin 


The  Diseases  of  the  Skin.  Their  Description,  Pathology, 
Diagnosis,  and  Treatment,  with  Special  Reference  to  the 
Skin  Eruptions  of  Children.  By  H.  Radcliffe  Crocker, 
M.D. ,  Physician  to  the  Department  of  Skin  Diseases,  Uni- 
versity College  Hospital,  London.      With  new  Illustrations. 

Third  Edition,   Rewritten  and  Enlarged 

NEARLY  READY?   CLOTH,  $5.00 

*^*  This  new  edition  will  easily  hold  the  high  position 
given  the  previous  printings.  The  author  is  a  member  of 
American,  English,  French,  German,  and  Italian  Dermato- 
logical  Societies,  and  a  recognized  authority  the  world  over. 


STURGIS— MANUAL  OF 
VENEREAL  DISEASES 


By  F.  R.  Sturgis,  m.d.,  Sometime  Clinical  Professor  of 
Venereal  Diseases  in  the  Medical  Department  of  the  Uni- 
versity of  the  City  of  New  York.  Seventh  Edition,  Revised 
and  in  Part  Rewritten  by  the  Author  and  FoLLEN  Cabot, 
M.D.,  Instructor  in  Genito-Urinary  and  Venereal  Diseases 
in  the  Cornell  University  Medical  College.  i2mo.  2i6 
pages.  Cloth,  ^1.2$ 

*^*  This  manual  was  originally  written  for  students' 
use,  and  is  as  concise  and  as  practical  as  possible.  It  pre- 
sents a  careful,  condensed  description  of  the  commoner 
forms  of  venereal  diseases  which  occur  in  the  practice  of 
the  general  physician,  together  with  the  most  approved 
remedies. 

30 


FOR  THE  DISSECTING  ROOM 

Holden's  Anatomy — Seventh  Edition 
320  Illustrations 

A  Manual  of  the  Dissections  of  the  Human  Body.  By  John 
Langton,  F.R.c.s.  Carefully  Revised  by  A.  Hewson,m.d., 
Demonstrator  of  Anatomy,  Jefferson  Medical  College,  Phila- 
delphia, etc.  320  Illustrations.  Two  small  compact  vol- 
umes.     i2mo. 

Vol.  I.  Scalp,  Face,  Orbit,  Neck,  Throat,  Thorax,  Upper 
Extremity.      435  pages.      153  Illustrations. 

Oil  Cloth,  |i. 50 

Vol.  II.  Abdomen,  Perineum,  Lower  Extremity,  Brain, 
Eye,  Ear,  iSIammary  Gland,  Scrotum,  Testes. 
445  pages.      167  Illustrations. 

Oil  Cloth,  $1.50 

Each  I'oluine  sold  separately . 


Hughes    aLnd    Keith  —  Dissections 

lUustrdLted 

A  Manual  of  Dissections  by  Alfred  W.  Hughes,  m.b., 
M.R.C.S.  (Edin. ),  late  Professor  of  Anatomy  and  Dean  of 
Medical  Faculty,  King's  College,  London,  etc.,  and  Arthur 
Keith,  M.d.,  Joint  Lecturer  en  Anatomy,  London  Hospital 
Medical  College,  etc.  In  three  parts.  With  527  Colored 
and  other  Illustrations. 

I.      Upper  and  Lower  Extremity.     38  Plates,  1 16  other 
Illustrations.  Cloth,  $3.00 

II.     Abdomen.      Thorax.     4    Plates,    149    other    Illus- 
trations. Cloth,  ^3.00 
III.      Head,    Neck,   and   Central   Nervous   System.       16 
Plates,  204  other  Illustrations.           Cloth,  ^3.00 

Each  volume  sold  sepa7'ately. 

*^*  The  student  will  find  it  of  great  advantage  to  have 
a    "Dissector"    to    supplement   his    regular   text-book    on 
anatomy.     These  books  meet  all  requirements,  and  as  they 
can  be  purchased  in  parts  as  wanted,  the  outlay  is  small. 
31 


EDGAR'S 

OBSTETRICS 

A   NEW   TEXT -BOOK 


I   s 


i    J 


The  Illustrations  in  Edgar's  Ob- 
stetrics surpass  in  number,  in  artistic 
beauty,  and  in  practical  worth  those 
in  any  book  of  similar  character.  They 
are  largely  from  original  sources,  are 
made  to  a  scale,  and  have  been  drawn 
by  artists  of  long  experience  in  this 
class  of  medical  work. 
The  Text  has  been  prepared  with 
great  care.  The  author's  extensive  ex- 
perience in  hospital  and  private  prac- 
tice and  as  a  teacher,  his  cosmopolitan 
knowledge  of  literature  and  methods, 
and  an  excellent  judgment  based  upon 
these  particularly  fit  him  to  prepare 
what  must  be  a  standard  work. 

I  A^      F  R  E  S  S 


^  1-- 


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